Pitfalls in respiratory allergy management: alexithymia and its impact on patient-reported outcomes.
OBJECTIVE
Alexithymia is a personality trait characterized by a limited ability to identify and express emotions and it represents a possible risk factor for disease development and management. The objective of the study is to evaluate alexithymia in patients with persistent asthma and comorbid rhinitis and its relation with patient-reported outcomes (PROs).


METHODS
Alexithymia, quality of life, illness perception, and stress were assessed, as well as rhinitis symptoms and asthma control in out-patients classified according to GINA and ARIA guidelines.


RESULTS
Out of 115 patients, 19% turned out to be alexithymic (TAS-20 ≥ 61). Concerning alexithymia level, no difference was detected between males and females (χ(2) = 0.317) and among GINA levels (χ(2) = 0.22). Alexithymics had significantly lower Asthma Control Test scores when compared with non-alexithymics (15.86 vs. 19; p = .02). Alexithymics had a worse quality of life (p< .001) and, concerning illness perception, they ascribed to respiratory allergy symptoms that are not strictly disease related and referred to asthma and rhinitis more serious negative consequences (p < .001) and emotional representations (p < .035). Moreover, they had lower illness coherence (p < .001) and lived their disease as a cyclical rather than a chronic disorder (p < .035). As regards stress, alexithymics reported less energy (p < .001), higher levels of tension (p < .001), depression (p < .001), confusion (p > .001), and inertia (p < .001).


CONCLUSIONS
Alexithymia is present in a relevant percentage of subjects and, as it can modulate illness perception, quality of life, and stress, it should be considered in disease management.
Allergy and Respiratory Disease Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy. ilaria.baiardini@libero.it
Ilaria
I
Baiardini
Fulvio
F
Braido
Gianluca
G
Ferraioli
Stefania
S
Menoni
Marco
M
Bruzzone
Maria Elisabetta
ME
Conte
Federica
F
Gani
Erminia
E
Ridolo
Antonio
A
Scordamaglia
Giorgio Walter
GW
Canonica
D000328:Adult; D000339:Affect; D000342:Affective Symptoms / Q000150:complications*; D001249:Asthma / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013315:Stress, Psychological; D016896:Treatment Outcome