title: Stress and anxiety effects on positive skin test responses in young adults with allergic rhinitis.
abstract: BACKGROUND
  Anxiety and psychological stress affect allergy-related immune function. How these relations influence the evaluations of patients with allergic rhinitis is unknown.
  
  
  OBJECTIVE
  To examine whether anxiety and stress exposure affect skin prick test (SPT) responses to common allergens for which patients with atopy showed no prior positive SPT response.
  
  
  METHODS
  Patients with allergic rhinitis, evidenced by clinical history and SPT results, were admitted twice to a hospital research unit for 4 hours. In a crossover design, SPT wheals were assessed before and after the Trier Social Stress Test and then the following morning; for comparison, SPT wheals were assessed before and after a laboratory session without a stressor. Analyses focused on wheal responses for common allergens that tested negative (wheal size <3 mm larger than saline) from SPTs performed at multiple baseline assessments.
  
  
  RESULTS
  After the Trier Social Stress Test, more anxious patients with atopy had a higher incidence of positive SPT reactions to antigens that previously tested negative. Anxiety was unrelated to positive SPT incidence under nonstressful conditions. Based on clinical symptom reports, newly positive SPT reactions after the stressor were apparently corrections of previously false-negative SPT reactions. The SPT wheal responses for allergens previously testing negative were enhanced after a stressor. Histamine (positive control) or saline (negative control) SPT responses were not affected.
  
  
  CONCLUSIONS
  A laboratory stressor affected allergen SPT responses in more anxious patients with allergic rhinitis. In addition to clinical history, assessment of anxiety and current stress at the time of the SPT may provide valuable information about a patient's allergic status and aid in clinical decision making.
authors.affiliation: University of Rochester School of Medicine and Dentistry, Department of Psychiatry, Rochester Center for Mind-Body Research, Rochester, New York. Electronic address: kathi_heffner@urmc.rochester.edu.
authors.forename: Kathi L
authors.initials: KL
authors.lastname: Heffner
authors.affiliation: The Ohio State University College of Medicine, Department of Psychiatry, The Institute for Behavioral Medicine Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
authors.forename: Janice K
authors.initials: JK
authors.lastname: Kiecolt-Glaser
authors.affiliation: The Ohio State University College of Medicine, Department of Molecular Virology, Immunology, and Medical Genetics, The Institute for Behavioral Medicine Research, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
authors.forename: Ronald
authors.initials: R
authors.lastname: Glaser
authors.affiliation: The Ohio State University, The Institute for Behavioral Medicine Research, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
authors.forename: William B
authors.initials: WB
authors.lastname: Malarkey
authors.affiliation: Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Gailen D
authors.initials: GD
authors.lastname: Marshall
mesh_terms: D000328:Adult; D000485:Allergens / Q000008:administration & dosage*; D000818:Animals; D001007:Anxiety / Q000139:chemically induced* / Q000150:complications / Q000276:immunology / Q000523:psychology; D015415:Biomarkers / Q000378:metabolism; D018592:Cross-Over Studies; D005260:Female; D006632:Histamine / Q000494:pharmacology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D011581:Psychological Tests; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000139:chemically induced* / Q000150:complications / Q000276:immunology / Q000523:psychology; D012463:Saliva / Q000737:chemistry; D012882:Skin Tests; D012965:Sodium Chloride / Q000494:pharmacology; D013315:Stress, Psychological / Q000150:complications / Q000276:immunology / Q000473:pathology*
chemical_list: D000485:Allergens; D015415:Biomarkers; D012965:Sodium Chloride; D006632:Histamine; D006854:Hydrocortisone
references.citation: Clin Exp Pharmacol Physiol. 2006 Aug;33(8):746-50
references.pmid: 16895550
references.citation: Ann Allergy Asthma Immunol. 1995 Nov;75(5):434-8
references.pmid: 7583866
references.citation: Clin Allergy Immunol. 2000;15:53-87
references.pmid: 10943288
references.citation: Ann Allergy Asthma Immunol. 2012 Jul;109(1):14-9
references.pmid: 22727152
references.citation: Allergy Asthma Proc. 2007 Jan-Feb;28(1):10-5
references.pmid: 17390750
references.citation: Int J Psychophysiol. 2002 May;44(2):165-75
references.pmid: 11909648
references.citation: Allergy. 1988 Nov;43(8):597-602
references.pmid: 3207182
references.citation: Brain Behav Immun. 2010 Nov;24(8):1347-53
references.pmid: 20633637
references.citation: Inflamm Res. 2009 Oct;58(10):631-8
references.pmid: 19440657
references.citation: Psychosom Med. 2003 Sep-Oct;65(5):816-23
references.pmid: 14508026
references.citation: Clin Exp Allergy. 2012 Dec;42(12):1765-71
references.pmid: 23181792
references.citation: Ann Allergy Asthma Immunol. 1995 Dec;75(6 Pt 2):543-625
references.pmid: 8521115
references.citation: Neurosci Biobehav Rev. 2010 Sep;35(1):46-50
references.pmid: 20096302
references.citation: Lancet. 2000 Sep 16;356(9234):982-7
references.pmid: 11041399
references.citation: Brain Behav Immun. 2007 Nov;21(8):993-9
references.pmid: 17493786
references.citation: Psychosom Med. 2004 May-Jun;66(3):349-55
references.pmid: 15184694
references.citation: Expert Rev Clin Immunol. 2012 Mar;8(3):235-41
references.pmid: 22390488
references.citation: Asian Pac J Allergy Immunol. 2012 Sep;30(3):185-92
references.pmid: 23156847
references.citation: Psychoneuroendocrinology. 2009 Jun;34(5):670-80
references.pmid: 19150180
references.citation: Psychosomatics. 1999 Nov-Dec;40(6):491-6
references.pmid: 10581977
references.citation: J Allergy Clin Immunol. 1999 Jul;104(1):173-6
references.pmid: 10400856
references.citation: Allergol Int. 2010 Jun;59(2):201-6
references.pmid: 20299824
references.citation: Neuropsychobiology. 1993;28(1-2):76-81
references.pmid: 8255414
references.citation: Allergy. 1993 Oct;48(7):498-503
references.pmid: 8238808
references.citation: Allergy. 2012 Nov;67(11):1408-14
references.pmid: 22943607
references.citation: Allergy. 2008 Mar;63(3):341-6
references.pmid: 18070229
references.citation: Am J Rhinol Allergy. 2012 Jan-Feb;26(1):e37-9
references.pmid: 22391080
references.citation: Am J Respir Crit Care Med. 2002 Apr 15;165(8):1062-7
references.pmid: 11956045