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Effects of Seasonal Allergic Rhinitis on Fatigue Levels and Mood

CITATION:  Marshall, P.S., O'Hara, C., et al.  (2002). Effects of Seasonal Allergic Rhinitis on Fatigue Levels and Mood.  Psychosomatic Medicine 64:684-691.


Objective: Many allergy patients complain of fatigue, moodiness, and dysphoria during their allergy seasons. This study evaluated the effect of symptomatic allergic rhinitis on both fatigue level and mood. 

Method: Symptomatic ragweed allergic rhinitis patients on no medications and healthy control subjects completed the Multi-Dimensional Fatigue Inventory and the Positive Affect-Negative Affect mood rating scales in an in-out-in ragweed season research design. 

Results: During ragweed seasons, allergic patients reported higher levels of general fatigue and mental fatigue, but not physical fatigue, as well as reduced motivation. Patients described experiencing feelings of greater sadness and reduced pleasurable engagement. Increased anxiety or emotional distress was not reported. 

Conclusions: These findings suggest that having allergic reactions to ragweed pollen causes significant fatigue and mood changes in at least a subgroup of patients. Psychoneuroimmunology and medical genetics research suggests that allergic reactions engender biochemical changes that directly affect the central nervous system. Key words: allergic rhinitis, fatigue, depression, mood.


1. Randolph T. An alternative approach to allergies. New York (NY): Lippincott Crowell; 1980.

2. Speer F. The allergic tension-fatigue syndrome. In: Speer F, editor. Allergy of the nervous system. Springfield (IL): Charles C. Thomas; 1970. p. 14-27.

3. Ossofsky H. Affective and allergic disorders and cyclic AMP. Compr Psychiatry 1976;17:335-46.

4. Nasr S, Altman E, Meltzer H. Concordance of allergic and affective disorders. J Affect Disord 1981;3:291-6.

5. Sugerman A, Southern D, Curran J. A study of antibody levels in alcoholic, depressive, and schizophrenic patients. Ann Allergy 1982;48:166-71.

6. Bell I, Jasnoski M, Kagan J, King D. Depression and allergies: survey of a nonclinical population. Psychother Psychosom 1991;55:24-31.

7. Addolorato G, Ancona C, Capristo E, Graziosetto R, Rienzo L, Maurizi M, Gasbarrini G. State and trait anxiety in women affected by allergic and vasomotor rhinitis. J Psychosom Res 1999;46(3):283-9.

8. Cohen P, Pine D, Must A, Kasan S, Brook J. Prospective associations between somatic illness and mental illness from child-hood to adulthood. Am J Epidemiol 1998;147(3):232-9.

9. Hurwitz E, Morgenstern H. Cross-sectional associations of asthma, hay fever, and other allergies with major depression and low-back pain among adults aged 20-39 years in the United States. Am J Epidemiol 1999;150(10):1107-16.

10. Marshall P, Colon E. Effects of allergy season on mood and cognitive function. Ann Allergy 1993;71(Pt 3):251-8.

11. Watson D, Clark L. Positive and negative affectivity and their relationship to anxiety and depressive disorders. J Abnorm Psychol 1988;87:346-53.

12. Marshall P, O'Hara C, Steinberg P. Effects of seasonal allergic rhinitis on selected cognitive abilities. Ann Allergy Asthma Immunol 2000;84:403-10.

13. Watson D, Clark L, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988;54:1063-70.

14. Smets E, Garssen B, Bonke B, DeHaes J. The multidimensional fatigue inventory (MFI). Psychomctric qualitics of an instrumcnt to assess fatigue. J Psychosom Res 1995;39(Pt 5):315-25.

15. Norusis M. SPSS for Windows: advanced statistics, release 6.0. Chicago (IL): SPSS, 1993.

16. Smith T. Happiness: time trends, seasonal variations, intersurvey differences, and other mysteries. Soc Psychol Q 1979;42: 18-30.

17. Pearson D. Psychologic and somatic interrelationships in allergy and pseudo allergy. J Allergy Clin Immunol 1988;81:351-60.

18. Craig T, Teets S, Lehman E, Chinchill V, Zwillich C. Nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and daytime fatigue and the response to topical nasal corticosteroids. J Allergy Clin Immunol 1998;101(5): 633-7.

19. Golbert T. Psychiatric aspects of allergic diseases. In: Patterson R, editor. Allergic diseases: diagnosis and management. 3rd ed. Philadelphia: Lippincott; 1985. p. 730-49.

20. Dantzer R, Aubert A, Bluthe R, Gheusi G, Cremona S, Laye S, Konsman J, Parnet P, Kelley K. Mechanisms of the behavioral effects of cytokines. In: Dantzer R, Wollman E, Yirmiya E, editors. Cytokines, stress, and depression. New York: Kluwer Academic/Plenum Publishers; 1999. p. 83-105.

21. Maier S, Watkins L, Nance D. Multiple routes of action of interleukin-1 on the nervous system. In: Ader R, Felten D, Cohen N, editors. Psychoneuroimmunology. 3rd edition. New York: Academic Press; 2001. p. 563-84.

22. Sim T, Grant A, Hilsmeier K, Fukuda Y, Alam R. Pro- inflammatory cytokines in nasal secretions of allergic subjects after antigen challenge. Am J Respir Crit Care Med 1994;149: 339-344.

23. Hastie A, Everts K, Cho S, Zangrilli J, Shaver J, Pollice M. IL-1 beta release from cultured bronchial epithelial cells and bronchoalveolar lavage cells from allergic and normal humans following segmental challenge with ragweed. Cytokine 1996;8: 730-8.

24. Calderon M, Devalia J, Prior A, Sapsford R, Davies R. A comparison of cytokine release from epithelial cells cultured from nasal biopsy specimens of atopic patients with and without rhinitis and nonatopic subjects without rhinitis. J Allergy Clin Immunol 1997;99:65-76.

25. Kobayashi H, Ishizuka T, Okayama Y. Human mast cells and basophils as sources of cytokines. Clin Exp Allergy 2000;30: 1205-12.

26. Undem B, Kajekar R, Hunter D, Myers A. Neural integration and allergic disease. J Allergy Clin Immunol 2000;106(5):5214-20.

27. Reichenberg A, Yirmiya R, Schuld A, Kraus T, Haack M, Morag A, Pollmacher T. Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry 2001;58:445-52.

28. Maes M. Major depression and activation of the inflammatory response system. In: Dantzer R, Wollman E, Yirmiya E, editors. Cytokines, stress, and depression. New York: Kluwer Academic/ Plenum Publishers; 1999. p. 25-46.

29. Levine J, Barak Y, Chengappa K, Rapoport A, Rebey M, Barak V. Cerebrospinal cytokine levels in patients with acute depression. Neuropsychobiology 1999;40:171-6.

30. Marshall P. Allergy and depression: a neurochemical threshold model of the relation between the illnesses. Psychol Bull 1993; 113(Pt 1):23-43.

31. Overstreet D. The Flinders sensitive line rats: a genetic animal model of depression. Neurosci Biobehav Rev 1993;17:51-68.

32. Djuric V, Overstreet D, Bienenstock J, Perdue M. Immediate hypersensitivity in the Flinders rat: further evidence for a possible link between susceptibility to allergies and depression. Brain Behav Immun 1995;9:196-206.

33. Djuric V, Cox G, Overstreet D, Smith L, Dragomir A, Steiner M. Genetically transmitted cholinergic hyperresponsiveness pre-disposes to experimental asthma. Brain Behav Immun 1998;12: 272-84.

34. Tilders F, Schmidt E. Cross-sensitization between immune and non-immune stressors: a role in the etiology of depression? In: Dantzer R, Wollman E, Yirmiya E, editors. Cytokines, stress, and depression. New York: Kluwer Academic/Plenum Publishers; 1999. p. 179-97.

35. Shintani F, Nakaki T, Kanba S, Sato K, Yagi G, Shiozawa M, Aiso S, Kato R, Asai M. Involvement of interleukin 1 in immobilization stress induced increase in plasma adrenocorticotropic hormone and in release of hypothalamic monoamines in the rat. J Neurosci 1995;15:1961-70.

36. Kubera M, Symbirtsev A, Basta-Kaim A, Borycz J, Roman A, Papp M, Claesson M. Effect of chronic treatment with imipramine on interleukin 1 and interleukin 2 production by splenocytes obtained from rats subjected to a chronic mild stress model of depression. Pol J Pharmacol 1996;48:503-6.

37. Nguyen K, Deak T, Owens S, Kohno T, Fleshner M, Watkins L, Maier S. Exposure to acute stress induces brain interleukin 1 beta protein in the rat. J Neurosci 1998;18:2239-46.

38. Nguyen K, Deak T, Will M, Hansen M, Hunsaker B, Fleshner M, Watkins L, Maier S. Timecourse and corticosterone sensitivity of the brain, pituitary, and serum interleukin-1 beta protein response to acute stress. Brain Res 2000;859:193-201.

39. Dilsaver S. Effects of stress on muscarinic mechanisms. Neuro-
sci Biobehav Rev 1988;12:23-8.

40. Dilsaver S, Snider R, Alessi N. Stress induces supersensitivity of a cholinergic system in rats. Biol Psychiatry 1986;21:1093-6.

41. Dilsaver S, Alessi N. Chronic inescapable foot shock produces
cholinergic system supersensitivity. Biol Psychiatry 1987;22: 910-4.

42. Wamboldt M, Schmitz S, Mrazek D. Genetic association between allergy and behavioral symptoms in middle childhood. J Child Psychol Psychiatry 1998;39:1007-16.

43. Wamboldt M, Hewitt J, Schmitz S, Wamboldt F, Rasanen M, Koskenvo M, Romanov K, Varjonen J, Kaprio J. Familial association between allergic disorders and depression in adult Finnish twins. Am J Med Genet 2000;96:146-53.