Allergy and asthma Flashcards
Race differences + asthma
4.6/10.000 black woman died of asthma compared to 2.7/10.000 white woman.
incidence rate ratio (IRR) + asthma
IRR were increased among woman who reported childhood abuse.
IRR for woman who felt in danger in the home in addition to being abused as children were higher than those for woman who were abused but did not feel in danger.
Physical abuse + asthma
Exposure to physical abuse during childhood was associated with an increased incidence for adult-onset asthma of greater than 20%. The risk was higher among women who also felt in danger in the home as a child.
IRR + sexual abuse
IRR were weaker for sexual abuse during childhood, and there was little evidence that abuse during adolescence increased asthma incidence.
Allergies
An immune-mediated hypersensitivity reaction
Different types of allergies
Asthma bronchial: 2-10% Exzema: 10-20% Pollen Food: 1-2% Drug: 5-20% Anaphylaxis <1%
Allergies + personality (early studies)
Neurotic trait = higher probability to get allergy as behavioral inhibition, introversion, social anxiety.
Alexithymia, passive, avoidance coping, high depndence
Allergies and personality (later studies)
higher hostility, high perfectionism, high need for being loved and need for approval, high rates of emotional coping, less satisfaction with family life, better financial situation (they are still less satisfies)
psychophysiological approaches to allergies
Dysfunction in the HPA axis
Dominance of the right hemisphere (alteration of laterality)
Bidirectional connection between the CNS and immune system components
Psychodynamic approach to allergies
Communication through the allergic symptom
Symptom as symbol of a psychological problem
Allergies + psychopathologies
There is a high correlation between allergic symptoms and anxiety, depression, exhaustion.
More than 50% of patient hd mild, medium or severe depression. (the direction can also go the other way around, because 40% of those who is depressed also get allergic symptoms)
Most frequent:
- panic disorder
- anxiety disorder
- phobias
- somatization problems
- sleep problems
Two types of pediatric asthma
Extrinsic and intrinsic
Extrinsic asthma
Atopic - associated with evidence of allergen sensitization.
Intrinsic asthma
Nonatopic - is brought by exercise or other triggers but does not have an obvious extrinsic trigger.
Symptoms of asthma
Shortness of breath Cough Wheezing Chest tightness Agitation HEart rate Respiratory rate
Prevalence of asthma
0-17 y: boys have higher rate
> 18 y: woman have higher rate
Psychosocial factor of asthma
- anxiety and fear of having an attack
- Uncertainty, because it is unpredictable and uncontrollable (learned helplessness)
- Unreleated emotional reactions and problems lead to more frequent visits to emergencies.
Environmental risk factors of asthma
house dust, cat and dog allergens, as well as exposure to environmental tobacco smoke in children over 6 years.
In children younger than 6 years, exposure to pet had a protective effect.
psychosocial risk factors of asthma
- preterm birth and eight gain predict childhood asthma
- Childhood physical and sexual abuse
- intimate partner violence exposure of the other (at 7month of age)
Psychosomatic risk factors of asthma
- ambivalence toward the mother
- asthma can be a sign of suppressed crying for the mother
Asthma and stress
Asthma people tend to have greater bronchoconstriction compared to healthy people in response to stress.
HPA xix have a reduced responsiveness to psychosocial stress
Rosenberg et al. (asthma)
Stress is likely to affect the onset and course of asthma by directly acting on pathogenic mechanisms in the airways
Asthma and panic
Its overrepresented among asthma patients.
Bidirectional interactions:
- Panic may elicit asthma symptoms
- Mild and severe asthma symptoms might trigger panic
Asthma and depression
People with depression is 3-17 times more likely to have a comorbidity of asthma compared with that of counterparts without depression.
people with asthma is 1.52 times more likely to have a comorbid depression compared with those without asthma.
Ortega
Asthma is associated with anxiety disorder, but not affective disorder
Asthma + behavioral problems
Asthma is associated with higher rate of behavioral problems
- low maternal education
- smoke in home
- parental asthma
- minor psychiatric disorder in mother
- mother drinks alcohol
Mechanisms of behavioral problems in asthma
Living with behavioral problems in childhood may affect the management of asthma symptoms and worsen it.
Bidirectional relationship between asthma and behavioral problems
Third variables: Low SES, maternal psychiatric problems
Asthma symptoms perception
Its important with symptom perception training, since you can either be overperceivers (take more medications than nneccesary) or underestimates (less medications).
Interventions focusing on environmental risk factors
- breastfeeding
- Food avoidance
- Maternal dietary allergen avoidance during pregnancy
- house dust mite avoidance
Breastfeeding (intervention)
Protective effect against asthma and allergic disease.
Infants fed with formulas of intact cow milk or soy protein compared with breast milk have a higher incidence of atopic dermatitis and wheezing illnesses in early childhood
Food avoidance
- avoidance of cow milk has been suggest for high-risk infants
House dust mite avoidacne
Show some benefit
Eczema (atopic dermatitis, AD) symptoms
- Rash that appear suddenly
- makes the skin dray, itchy
- form on the scalp and face
- causes itches that comes on go
- skin infections
- with time: thicken skin
adults: have more severe symptoms
eczema + epidemiology
10-20% children
1-3% adults
eczema + outcome
For some children, the condition completely disappears by age 2
About half of the children who get AD will have it as adults
Cause of atopic dermatitis
Children are more likely to develop AD if one of the parents has AD, asthma or hay fever.
Risk factor of AD
- family member who have AD
- where the child lives (e.g. city with high pollution)
- gender: females are more likely than males
- mothers age when child is born: the older the mother > more likely for the child to get AD
- social class: more common in higher social classes
Treatment of AD
Cant cure AD, but can control it.
Treatment can:
- prevent for getting worse
- calm the skin
- relieving pain and itch
- reduce emotional tress
- prevent infections
- stop skin from thickening
- control itching
Psychodetermatology
Interaction between skin, mind and body
Goal of psychodermatology treatment
not only to improve conditions of the skin, but also teach patient/carers how to cope with the disease
AD is psychophysiology disorder?
because it is not caused by stress, but appears to be precipitated by stress in some patients, and emotional factors can determine the natural course of the disease.
However chronic stress flares up pre-existing dermatosis.
Catecholamines
adrenaline + noradrenaline have effect on the immune system. increased allergic inflammatory response
Cortisol + AD
Cortisol act as a negative feedback mediator in the hypothalamus and inhibit the furter release of corticotrophin.
psychodermatological aspect of itch
emotional factors can cause, and frequently heighten the itching and scratching behavior, which can lead to serious impairment in QoL.
culture + eczema
in culture that values smooth, perfect skin, disfigured skin can cause stigmatization, social withdrawal, anxiety and depression
Eczema + QoL (children)
the impact of AD on QoL is high.
Infant with AD: significant dependents or clinginess, fearfulness, and behavioral problems compared to control population.
Ad causes irritability, sleep disturbance, anxiety and depression in children.
Eczema + QoL (adults)
frequently observed in people with AD are: self-image issues, hostile personality characteristics, dysthymic states and neurotic symptoms.
Can affect interpersonal relationships, decrease sexual desire, reduce work productivity and affect social/leisure activities. They are more restless in their sleep, more wake, spend less time asleep.
Has an affect on psychological well-being, comorbidity with anxiety, depression and sucicideal ideation
Treatment
Psychological intervention:
- Education !!!
- Brief dynamic psychotherapy
- biofeedback
- CBT
- relaxation techniques and hypnosis
