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Mental Health in Allergic Rhinitis: Depression and Suicidal Behavior

  • Allergic Rhinitis (J Máspero, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion statement

A high proportion of suicides visit their medical provider in the month prior to death, but depression, suicidal thoughts, and substance use are seldom addressed. For the clinicians routinely treating a substantial patient population with allergic diseases, there are additional concerns, as allergy has been linked with both depression and suicidal behavior. While psychotropic medications may affect diagnosis of allergies, medications used to treat allergies impact mood and behavior. Thus, we present an overview of the overlap of allergic rhinitis with depression and suicidal behavior in adults, based on clinical and epidemiological data, and our research and clinical experience. In summary, we suggest: (1) inquiring among patients with allergies about personal and family history of depression, substance use disorders, suicidal ideation, and attempts; (2) increased mindfulness regarding the potential effects of allergy medications on mood and behavior; and (3) for people identified with certain types of depression or increased suicide risk, a systematic multilevel collaborative approach. While, for practical reasons the majority of patients with depression will continue to be treated by general or family practitioners, the allergy-treating provider should always consider integrated care for bipolar, psychotic, or suicidal depression and incomplete remission, or relapsing and highly recurrent course. While awaiting results of a much needed basic and clinical research to guide the clinical approach to patients with comorbid allergic rhinitis and depression, the simple steps recommended here are expected to lead to improved clinical outcomes in depression, and, perhaps, contributing to lowering the highly resilient suicide mortality.Learning objectives: a) Present overlaps between allergy, allergen exposure, depression, and suicidal behavior in adults and b) Familiarize allergists with the principles of diagnosis and treatment of depression in adults and importance to monitor suicide risk.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• of major importance

  1. Summary Health Statistics for US Adults: National Health Interview Survey, 2012. In: Resources USDoHaH, editor. Hyattsville, MD: DHHS; 2014.

  2. Summary Health Statistics for US Children: National Health Interview Survey, 2012. In: Resources USDoHaH, editor. Hyattsville, MD: DHHS; 2014.

  3. Wu WF, Wan KS, Wang SJ, Yang W, Liu WL. Prevalence, severity, and time trends of allergic conditions in 6-to-7-year-old schoolchildren in Taipei. J Investig Allergol Clin Immunol. 2011;21(7):556–62.

    CAS  PubMed  Google Scholar 

  4. Abdulrahman H, Hadi U, Tarraf H, Gharagozlou M, Kamel M, Soliman A, et al. Nasal allergies in the Middle Eastern population: results from the “allergies in Middle East survey”. Am J Rhinol Allergy. 2012;26(Suppl 1):S3–23. doi:10.2500/ajra.2012.26.3836.

    Article  PubMed  Google Scholar 

  5. Blaiss MS. Allergic rhinitis: direct and indirect costs. Allergy Asthma Proc. 2010;31(5):375–80. doi:10.2500/aap.2010.31.3329.

    Article  PubMed  Google Scholar 

  6. Meltzer EO, Bukstein DA. The economic impact of allergic rhinitis and current guidelines for treatment. Ann Allergy Asthma Immunol. 2011;106(2 Suppl):S12–6. doi:10.1016/j.anai.2010.10.014.

    Article  PubMed  Google Scholar 

  7. Ozdoganoglu T, Songu M, Inancli HM. Quality of life in allergic rhinitis. Ther Adv Respir Dis. 2012;6(1):25–39. doi:10.1177/1753465811424425.

    Article  PubMed  Google Scholar 

  8. Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–76. doi:10.1016/j.jaci.2010.06.047.

    Article  PubMed  Google Scholar 

  9. Passali D, Passali GC, Lauriello M, Romano A, Bellussi L, Passali FM. Nasal allergy and otitis media: a real correlation? Sultan Qaboos Univ Med J. 2014;14(1):e59–64.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kirtsreesakul V, Naclerio RM. Role of allergy in rhinosinusitis. Curr Opin Allergy Clin Immunol. 2004;4(1):17–23.

    Article  CAS  PubMed  Google Scholar 

  11. Ameli F, Brocchetti F, Tosca MA, Signori A, Ciprandi G. Adenoidal hypertrophy and allergic rhinitis: is there an inverse relationship? Am J Rhinol Allergy. 2013;27(1):e5–10. doi:10.2500/ajra.2013.27.3854.

    Article  PubMed  Google Scholar 

  12. Craig TJ, Sherkat A, Safaee S. Congestion and sleep impairment in allergic rhinitis. Curr Allergy Asthma Rep. 2010;10(2):113–21. doi:10.1007/s11882-010-0091-5.

    Article  PubMed  Google Scholar 

  13. Goodwin RD, Demmer RT, Galea S, Lemeshow AR, Ortega AN, Beautrais A. Asthma and suicide behaviors: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Psychiatr Res. 2012;46(8):1002–7. doi:10.1016/j.jpsychires.2012.04.024.

    Article  PubMed  Google Scholar 

  14. Qin P, Mortensen PB, Waltoft BL, Postolache TT. Allergy is associated with suicide completion with a possible mediating role of mood disorder—a population-based study. Allergy. 2011;66(5):658–64. doi:10.1111/j.1398-9995.2010.02523.x.

    Article  CAS  PubMed  Google Scholar 

  15. Timonen M, Jokelainen J, Silvennoinen-Kassinen S, Herva A, Zitting P, Xu B, et al. Association between skin test diagnosed atopy and professionally diagnosed depression: a Northern Finland 1966 Birth Cohort study. Biol Psychiatry. 2002;52(4):349–55.

    Article  PubMed  Google Scholar 

  16. Timonen M, Jokelainen J, Hakko H, Silvennoinen-Kassinen S, Meyer-Rochow VB, Herva A, et al. Atopy and depression: results from the Northern Finland 1966 Birth Cohort study. Mol Psychiatry. 2003;8(8):738–44. doi:10.1038/sj.mp.4001274.

    Article  CAS  PubMed  Google Scholar 

  17. Timonen M, Jokelainen J, Herva A, Zitting P, Meyer-Rochow VB, Rasanen P. Presence of atopy in first-degree relatives as a predictor of a female proband’s depression: results from the Northern Finland 1966 Birth Cohort. J Allergy Clin Immunol. 2003;111(6):1249–54.

    Article  PubMed  Google Scholar 

  18. Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, et al. Allergic rhinitis in adolescence increases the risk of depression in later life: a nationwide population-based prospective cohort study. J Affect Disord. 2013;145(1):49–53. doi:10.1016/j.jad.2012.07.011.

    Article  PubMed  Google Scholar 

  19. Chen MH, Lan WH, Hsu JW, Huang KL, Chen YS, Li CT, et al. Risk of bipolar disorder among adolescents with allergic rhinitis: a nationwide longitudinal study. J Psychosom Res. 2015;79(6):533–6. doi:10.1016/j.jpsychores.2015.08.009.

    Article  PubMed  Google Scholar 

  20. Wamboldt MZ, Hewitt JK, Schmitz S, Wamboldt FS, Rasanen M, Koskenvuo M, et al. Familial association between allergic disorders and depression in adult Finnish twins. Am J Med Genet. 2000;96(2):146–53.

    Article  CAS  PubMed  Google Scholar 

  21. Marshall PS, O'Hara C, Steinberg P. Effects of seasonal allergic rhinitis on fatigue levels and mood. Psychosom Med. 2002;64(4):684–91.

    PubMed  Google Scholar 

  22. Postolache TT, Stiller JW, Herrell R, Goldstein MA, Shreeram SS, Zebrak R, et al. Tree pollen peaks are associated with increased nonviolent suicide in women. Mol Psychiatry. 2005;10(3):232–5. doi:10.1038/sj.mp.4001620.

    Article  CAS  PubMed  Google Scholar 

  23. Qin P, Waltoft BL, Mortensen PB, Postolache TT. Suicide risk in relation to air pollen counts: a study based on data from Danish registers. BMJ Open. 2013;3(5) doi:10.1136/bmjopen-2012-002462.

  24. Stipic-Markovic A, Pevec B, Pevec MR, Custovic A. Prevalence of symptoms of asthma, allergic rhinitis, conjunctivitis and atopic eczema: ISAAC (International Study of Asthma and Allergies in Childhood) in a population of schoolchildren in Zagreb. Acta Med Croatica. 2003;57(4):281–5.

    PubMed  Google Scholar 

  25. Bjorksten B, Clayton T, Ellwood P, Stewart A, Strachan D. Worldwide time trends for symptoms of rhinitis and conjunctivitis: phase III of the International Study of Asthma and Allergies in Childhood. Pediatr Allergy Immunol. 2008;19(2):110–24. doi:10.1111/j.1399-3038.2007.00601.x.

    Article  PubMed  Google Scholar 

  26. Strachan DP. Family size, infection and atopy: the first decade of the “hygiene hypothesis”. Thorax. 2000;55(Suppl 1):S2–10.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rook GA, Adams V, Hunt J, Palmer R, Martinelli R, Brunet LR. Mycobacteria and other environmental organisms as immunomodulators for immunoregulatory disorders. Springer Semin Immunopathol. 2004;25(3–4):237–55. doi:10.1007/s00281-003-0148-9.

    Article  CAS  PubMed  Google Scholar 

  28. •• Stein MM, Hrusch CL, Gozdz J, Igartua C, Pivniouk V, Murray SE, et al. Innate immunity and asthma risk in Amish and Hutterite farm children. N Engl J Med. 2016;375(5):411–21. doi:10.1056/NEJMoa1508749.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Rook GA, Raison CL, Lowry CA. Microbiota, immunoregulatory old friends and psychiatric disorders. Adv Exp Med Biol. 2014;817:319–56. doi:10.1007/978-1-4939-0897-4_15.

    Article  CAS  PubMed  Google Scholar 

  30. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. Clinical practice guideline: allergic rhinitis. Otolaryngology—Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2015;152(1 Suppl):S1–43. doi:10.1177/0194599814561600.

    Article  Google Scholar 

  31. Bousquet J, Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108 doi:10.1067/mai.2001.118891.

  32. Hamilton RG. Allergic sensitization is a key risk factor for but not synonymous with allergic disease. J Allergy Clin Immunol. 2014;134(2):360–1. doi:10.1016/j.jaci.2014.02.022.

    Article  PubMed  Google Scholar 

  33. Han DH, Rhee C-S. Comorbidities of allergic rhinitis. In: Pereira PC, editor. Allergic diseases—highlights in the clinic, mechanisms and treatment. InTech; 2012.

  34. Hadley JA, Derebery MJ, Marple BF. Comorbidities and allergic rhinitis: not just a runny nose. J Fam Pract. 2012;61(2 Suppl):S11–5.

    PubMed  Google Scholar 

  35. •• Scadding GK, Scadding GW. Diagnosing allergic rhinitis. Immunol Allergy Clin N Am. 2016;36(2):249–60. doi:10.1016/j.iac.2015.12.003.

    Article  Google Scholar 

  36. Adkinson Jr NF, Hamilton RG. Clinical history-driven diagnosis of allergic diseases: utilizing in vitro IgE testing. J Allergy Clin Immunol Pract. 2015;3(6):871–6. quiz 7-8 doi:10.1016/j.jaip.2015.08.002.

    Article  PubMed  Google Scholar 

  37. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 Suppl 3):S1–148.

    CAS  Google Scholar 

  38. Antico A, Lima G, Arisi M, Ostan A, Morrica B. Assay of prick test inoculum volume. II. Average values and individual variability. Ann Allergy Asthma Immunol. 2000;85(2):145–9. doi:10.1016/s1081-1206(10)62455-6.

    Article  CAS  PubMed  Google Scholar 

  39. Chinoy B, Yee E, Bahna SL. Skin testing versus radioallergosorbent testing for indoor allergens. Clin Mol Allergy. 2005;3(1):4. doi:10.1186/1476-7961-3-4.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hamilton RG, Oppenheimer J. Serological IgE analyses in the diagnostic algorithm for allergic disease. J Allergy Clin Immunol Pract. 2015;3(6):833–40. quiz 41-2 doi:10.1016/j.jaip.2015.08.016.

    Article  PubMed  Google Scholar 

  41. Dordal MT, Lluch-Bernal M, Sanchez MC, Rondon C, Navarro A, Montoro J, et al. Allergen-specific nasal provocation testing: review by the rhinoconjunctivitis committee of the Spanish Society of Allergy and Clinical Immunology. J Investig Allergol Clin Immunol. 2011;21(1):1–12. quiz follow

    CAS  Google Scholar 

  42. Ito K, Weinberger KR, Robinson GS, Sheffield PE, Lall R, Mathes R, et al. The associations between daily spring pollen counts, over-the-counter allergy medication sales, and asthma syndrome emergency department visits in New York City, 2002-2012. Environ Health. 2015;14:71. doi:10.1186/s12940-015-0057-0.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Martin BG, Mansfield LE, Nelson HS. Cross-allergenicity among the grasses. Ann Allergy. 1985;54(2):99–104.

    CAS  PubMed  Google Scholar 

  44. Wodehouse RP. Hayfever plants. New York: Hafner Publishing; 1971.

    Google Scholar 

  45. Frenz DA. Volumetric ragweed pollen data for eight cities in the continental United States. Ann Allergy Asthma Immunol. 1999;82(1):41–6. doi:10.1016/s1081-1206(10)62658-0.

    Article  CAS  PubMed  Google Scholar 

  46. Stinson KA, Albertine JM, Hancock LM, Seidler TG, Rogers CA. Northern ragweed ecotypes flower earlier and longer in response to elevated CO2: what are you sneezing at? Oecologia. 2016; doi:10.1007/s00442-016-3670-x.

    PubMed  PubMed Central  Google Scholar 

  47. Athanasios DDV, Dimitrios G, John H. Long-term trends in airborne fungal-spore concentrations: a comparison with pollen. Fungal Ecol. 2015;13(6):150. doi:10.1016/j.funeco.2014.09.010.

    Google Scholar 

  48. Baxi SN, Portnoy JM, Larenas-Linnemann D, Phipatanakul W. Exposure and health effects of fungi on humans. J Allergy Clin Immunol Pract. 2016;4(3):396–404. doi:10.1016/j.jaip.2016.01.008.

    Article  PubMed  Google Scholar 

  49. Huss K, Adkinson Jr NF, Eggleston PA, Dawson C, Van Natta ML, Hamilton RG. House dust mite and cockroach exposure are strong risk factors for positive allergy skin test responses in the Childhood Asthma Management Program. J Allergy Clin Immunol. 2001;107(1):48–54. doi:10.1067/mai.2001.111146.

    Article  CAS  PubMed  Google Scholar 

  50. Pomes A, Chapman MD, Wunschmann S. Indoor allergens and allergic respiratory disease. Curr Allergy Asthma Rep. 2016;16(6):43. doi:10.1007/s11882-016-0622-9.

    Article  PubMed  CAS  Google Scholar 

  51. Hox V, Steelant B, Fokkens W, Nemery B, Hellings PW. Occupational upper airway disease: how work affects the nose. Allergy. 2014;69(3):282–91. doi:10.1111/all.12347.

    Article  CAS  PubMed  Google Scholar 

  52. H RA. Allergic toxemia and migraine due to food allergy: report of cases. Cal West Med. 1930;33:785–93.

    Google Scholar 

  53. Association AP. Diagnostic and Statistical Manual of Mental Disorders. 5 ed. Washington, DC: 2013.

  54. Association AP. Depressive disorders. Diagnostic and Statistical Manual of Mental Disorders. DSM Library: American Psychiatric Association; 2013.

  55. Association AP. Bipolar and related disorders. Diagnostic and Statistical Manual of Mental Disorders. DSM Library: American Psychiatric Association; 2013.

  56. Sarra L. Hedden JK, Rachel Lipari, Grace Medley, Peter Tice. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. In: Administration SAaMHS, editor. Rockville, MD: HHS Publication; 2015.

  57. Silverstein B. Gender differences in the prevalence of somatic versus pure depression: a replication. Am J Psychiatry. 2002;159(6):1051–2. doi:10.1176/appi.ajp.159.6.1051.

    Article  PubMed  Google Scholar 

  58. Halbreich U, Kahn LS. Atypical depression, somatic depression and anxious depression in women: are they gender-preferred phenotypes? J Affect Disord. 2007;102(1–3):245–58. doi:10.1016/j.jad.2006.09.023.

    Article  PubMed  Google Scholar 

  59. Bender A, Farvolden P. Depression and the workplace: a progress report. Curr Psychiatry Rep. 2008;10(1):73–9.

    Article  PubMed  Google Scholar 

  60. Koinis-Mitchell D, Craig T, Esteban CA, Klein RB. Sleep and allergic disease: a summary of the literature and future directions for research. J Allergy Clin Immunol. 2012;130(6):1275–81. doi:10.1016/j.jaci.2012.06.026.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Proudfoot J, Doran J, Manicavasagar V, Parker G. The precipitants of manic/hypomanic episodes in the context of bipolar disorder: a review. J Affect Disord. 2011;133(3):381–7. doi:10.1016/j.jad.2010.10.051.

    Article  PubMed  Google Scholar 

  62. Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med. 2005;352(24):2515–23. doi:10.1056/NEJMsa043266.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Control NCfIPa. Self-directed violence surveillance: uniform definitions and recommended data elements. In: Prevention CfDCa, editor. Atlanta, Georgia 2011.

  64. Jager-Hyman S, Cunningham A, Wenzel A, Mattei S, Brown GK, Beck AT. Cognitive distortions and suicide attempts. Cognit Ther Res. 2014;38(4):369–74. doi:10.1007/s10608-014-9613-0.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Beck AT, Steer RA, Beck JS, Newman CF. Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide Life Threat Behav. 1993;23(2):139–45.

    CAS  PubMed  Google Scholar 

  66. Sally C. Curtin MA, Margaret Warner, Holly Hedegaard. Increase in suicide in the United States, 1999–2014. In: Services UdoHaH, editor. 1600 Clifton Road Atlanta, GA 30329-4027 USA 2016.

  67. Suicide Facts at a Glance. In: Control NCfIPa, editor.; 2015.

  68. World Health Organization (WHO). Suicide huge but preventable public health problem. Geneva: 2004.

  69. Fawcett J. Frontiers in neuroscience diagnosis, traits, states, and comorbidity in suicide. In: Dwivedi Y, editor. The neurobiological basis of suicide. Boca Raton (FL): CRC Press/Taylor & Francis Llc; 2012.

    Google Scholar 

  70. Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: a meta-analytic review. Clin Psychol Rev. 2016;43:30–46. doi:10.1016/j.cpr.2015.11.008.

    Article  PubMed  Google Scholar 

  71. Weiser M, Goldberg S, Werbeloff N, Fenchel D, Reichenberg A, Shelef L, et al. Risk of completed suicide in 89,049 young males assessed by a mental health professional. Eur Neuropsychopharmacol. 2016;26(2):341–9. doi:10.1016/j.euroneuro.2015.12.001.

    Article  CAS  PubMed  Google Scholar 

  72. U.S.A. Suicide 2013. Official final data. Washington, DC: American Association of Suicidology [database on the Internet]. American Association of Suicidology. 2015. Available from: http://www.suicidology.org.

  73. Cooper J, Kapur N, Webb R, Lawlor M, Guthrie E, Mackway-Jones K, et al. Suicide after deliberate self-harm: a 4-year cohort study. Am J Psychiatry. 2005;162(2):297–303. doi:10.1176/appi.ajp.162.2.297.

    Article  PubMed  Google Scholar 

  74. Hawton K, van Heeringen K. Suicide Lancet. 2009;373(9672):1372–81. doi:10.1016/s0140-6736(09)60372-x.

    Article  PubMed  Google Scholar 

  75. Nordentoft M, Mortensen PB, Pedersen CB. Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry. 2011;68(10):1058–64. doi:10.1001/archgenpsychiatry.2011.113.

    Article  PubMed  Google Scholar 

  76. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266–77. doi:10.1176/appi.ajp.2011.10111704.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999;156(2):181–9. doi:10.1176/ajp.156.2.181.

    CAS  PubMed  Google Scholar 

  78. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner Jr TE. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575–600. doi:10.1037/a0018697.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Postolache TT, Komarow H, Tonelli LH. Allergy: a risk factor for suicide? Curr Treat Options Neurol. 2008;10(5):363–76.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Postolache T.T. M, Komarow H.D. M, Stiller J.W. M, Tonelli L.H. P. Allergy, Depression, and Suicide. Directions in Psychiatry. 2005;25.

  81. Blaiss M, Reigel T, Philpot E. A study to determine the impact of rhinitis on sufferers’ sleep and daily routine. J Allergy Clin Immunol. 115(2):S197. doi:10.1016/j.jaci.2004.12.800.

  82. KleinJan A, Vinke JG, Severijnen LW, Fokkens WJ. Local production and detection of (specific) IgE in nasal B-cells and plasma cells of allergic rhinitis patients. Eur Respir J. 2000;15(3):491–7.

    Article  CAS  PubMed  Google Scholar 

  83. Kouro T, Takatsu K. IL-5- and eosinophil-mediated inflammation: from discovery to therapy. Int Immunol. 2009;21(12):1303–9. doi:10.1093/intimm/dxp102.

    Article  CAS  PubMed  Google Scholar 

  84. Gushchin IS. Molecular basis of allergy control. Patol Fiziol Eksp Ter. 2005;(2):2–9.

  85. Gould HJ, Sutton BJ. IgE in allergy and asthma today. Nat Rev Immunol. 2008;8(3):205–17. doi:10.1038/nri2273.

    Article  CAS  PubMed  Google Scholar 

  86. Min YG. The pathophysiology, diagnosis and treatment of allergic rhinitis. Allergy Asthma Immunol Res. 2010;2(2):65–76. doi:10.4168/aair.2010.2.2.65.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Galli SJ, Tsai M. IgE and mast cells in allergic disease. Nat Med. 2012;18(5):693–704. doi:10.1038/nm.2755.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Hardyman MA, Wilkinson E, Martin E, Jayasekera NP, Blume C, Swindle EJ, et al. TNF-alpha-mediated bronchial barrier disruption and regulation by src-family kinase activation. J Allergy Clin Immunol. 2013;132(3):665–75.e8. doi:10.1016/j.jaci.2013.03.005.

    Article  CAS  PubMed  Google Scholar 

  89. Gandhi VD, Vliagoftis H. Airway epithelium interactions with aeroallergens: role of secreted cytokines and chemokines in innate immunity. Front Immunol. 2015;6:147. doi:10.3389/fimmu.2015.00147.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  90. Commins SP, Borish L, Steinke JW. Immunologic messenger molecules: cytokines, interferons, and chemokines. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S53–72. doi:10.1016/j.jaci.2009.07.008.

    Article  PubMed  Google Scholar 

  91. Xue L, Gyles SL, Wettey FR, Gazi L, Townsend E, Hunter MG, et al. Prostaglandin D2 causes preferential induction of proinflammatory Th2 cytokine production through an action on chemoattractant receptor-like molecule expressed on Th2 cells. J Immunol. 2005;175(10):6531–6.

    Article  CAS  PubMed  Google Scholar 

  92. Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31. doi:10.1016/j.it.2005.11.006.

    Article  CAS  PubMed  Google Scholar 

  93. Ross TM, Zuckermann RN, Reinhard C, Frey 2nd WH. Intranasal administration delivers peptoids to the rat central nervous system. Neurosci Lett. 2008;439(1):30–3. doi:10.1016/j.neulet.2008.04.097.

    Article  CAS  PubMed  Google Scholar 

  94. Kalueff AV, Lehtimaki KA, Ylinen A, Honkaniemi J, Peltola J. Intranasal administration of human IL-6 increases the severity of chemically induced seizures in rats. Neurosci Lett. 2004;365(2):106–10. doi:10.1016/j.neulet.2004.04.061.

    Article  CAS  PubMed  Google Scholar 

  95. Thorne RG, Pronk GJ, Padmanabhan V, Frey 2nd WH. Delivery of insulin-like growth factor-I to the rat brain and spinal cord along olfactory and trigeminal pathways following intranasal administration. Neuroscience. 2004;127(2):481–96. doi:10.1016/j.neuroscience.2004.05.029.

    Article  CAS  PubMed  Google Scholar 

  96. Ross TM, Martinez PM, Renner JC, Thorne RG, Hanson LR, Frey 2nd WH. Intranasal administration of interferon beta bypasses the blood-brain barrier to target the central nervous system and cervical lymph nodes: a non-invasive treatment strategy for multiple sclerosis. J Neuroimmunol. 2004;151(1–2):66–77. doi:10.1016/j.jneuroim.2004.02.011.

    Article  CAS  PubMed  Google Scholar 

  97. Reichenberg A, Yirmiya R, Schuld A, Kraus T, Haack M, Morag A, et al. Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry. 2001;58(5):445–52.

    Article  CAS  PubMed  Google Scholar 

  98. Tonelli LH, Postolache TT. Airborne inflammatory factors: “from the nose to the brain”. Front Biosci (Schol Ed). 2010;2:135–52.

    Article  Google Scholar 

  99. Musselman DL, Miller AH, Porter MR, Manatunga A, Gao F, Penna S, et al. Higher than normal plasma interleukin-6 concentrations in cancer patients with depression: preliminary findings. Am J Psychiatry. 2001;158(8):1252–7. doi:10.1176/appi.ajp.158.8.1252.

    Article  CAS  PubMed  Google Scholar 

  100. Liu Y, Ho RC, Mak A. Interleukin (IL)-6, tumour necrosis factor alpha (TNF-alpha) and soluble interleukin-2 receptors (sIL-2R) are elevated in patients with major depressive disorder: a meta-analysis and meta-regression. J Affect Disord. 2012;139(3):230–9. doi:10.1016/j.jad.2011.08.003.

    Article  CAS  PubMed  Google Scholar 

  101. Bahrini L, Ouanes S, Ghachem R. Inflammatory profile in depression and associated clinical and sociodemographic features in a middle-eastern north-African population. J Affect Disord. 2016;198:122–6. doi:10.1016/j.jad.2016.03.036.

    Article  PubMed  Google Scholar 

  102. Levine J, Barak Y, Chengappa KN, Rapoport A, Rebey M, Barak V. Cerebrospinal cytokine levels in patients with acute depression. Neuropsychobiology. 1999;40(4):171–6.

    Article  CAS  PubMed  Google Scholar 

  103. Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, et al. A meta-analysis of cytokines in major depression. Biol Psychiatry. 2010;67(5):446–57. doi:10.1016/j.biopsych.2009.09.033.

    Article  CAS  PubMed  Google Scholar 

  104. Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009;71(2):171–86. doi:10.1097/PSY.0b013e3181907c1b.

    Article  CAS  PubMed  Google Scholar 

  105. Lanquillon S, Krieg JC, Bening-Abu-Shach U, Vedder H. Cytokine production and treatment response in major depressive disorder. Neuropsychopharmacology. 2000;22(4):370–9. doi:10.1016/s0893-133x(99)00134-7.

    Article  CAS  PubMed  Google Scholar 

  106. Eyre HA, Lavretsky H, Kartika J, Qassim A, Baune BT. Modulatory effects of antidepressant classes on the innate and adaptive immune system in depression. Pharmacopsychiatry. 2016;49(3):85–96. doi:10.1055/s-0042-103159.

    Article  CAS  PubMed  Google Scholar 

  107. Buttini M, Boddeke H. Peripheral lipopolysaccharide stimulation induces interleukin-1 beta messenger RNA in rat brain microglial cells. Neuroscience. 1995;65(2):523–30.

    Article  CAS  PubMed  Google Scholar 

  108. Konsman JP, Kelley K, Dantzer R. Temporal and spatial relationships between lipopolysaccharide-induced expression of Fos, interleukin-1beta and inducible nitric oxide synthase in rat brain. Neuroscience. 1999;89(2):535–48.

    Article  CAS  PubMed  Google Scholar 

  109. Quan N, Whiteside M, Herkenham M. Time course and localization patterns of interleukin-1beta messenger RNA expression in brain and pituitary after peripheral administration of lipopolysaccharide. Neuroscience. 1998;83(1):281–93.

    Article  CAS  PubMed  Google Scholar 

  110. Bay-Richter C, Janelidze S, Hallberg L, Brundin L. Changes in behaviour and cytokine expression upon a peripheral immune challenge. Behav Brain Res. 2011;222(1):193–9. doi:10.1016/j.bbr.2011.03.060.

    Article  CAS  PubMed  Google Scholar 

  111. Pace TW, Hu F, Miller AH. Cytokine-effects on glucocorticoid receptor function: relevance to glucocorticoid resistance and the pathophysiology and treatment of major depression. Brain Behav Immun. 2007;21(1):9–19. doi:10.1016/j.bbi.2006.08.009.

    Article  CAS  PubMed  Google Scholar 

  112. Gold PW, Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Mol Psychiatry. 2002;7(3):254–75. doi:10.1038/sj.mp.4001032.

    Article  CAS  PubMed  Google Scholar 

  113. Scadding G. Cytokine profiles in allergic rhinitis. Curr Allergy Asthma Rep. 2014;14(5):435. doi:10.1007/s11882-014-0435-7.

    Article  PubMed  CAS  Google Scholar 

  114. Bedolla-Barajas M, Morales-Romero J, Pulido-Guillen NA, Robles-Figueroa M, Plascencia-Dominguez BR. Rhinitis as an associated factor for anxiety and depression amongst adults. Braz J Otorhinolaryngol. 2016; doi:10.1016/j.bjorl.2016.05.008.

    PubMed  Google Scholar 

  115. •• Brundin L, Erhardt S, Bryleva EY, Achtyes ED, Postolache TT. The role of inflammation in suicidal behaviour. Acta Psychiatr Scand. 2015;132(3):192–203. doi:10.1111/acps.12458.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Bay-Richter C, Linderholm KR, Lim CK, Samuelsson M, Traskman-Bendz L, Guillemin GJ, et al. A role for inflammatory metabolites as modulators of the glutamate N-methyl-D-aspartate receptor in depression and suicidality. Brain Behav Immun. 2015;43:110–7. doi:10.1016/j.bbi.2014.07.012.

    Article  CAS  PubMed  Google Scholar 

  117. Oxenkrug G. Serotonin-kynurenine hypothesis of depression: historical overview and recent developments. Curr Drug Targets. 2013;14(5):514–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  118. Parrott JM, Redus L, O'Connor JC. Kynurenine metabolic balance is disrupted in the hippocampus following peripheral lipopolysaccharide challenge. J Neuroinflammation. 2016;13(1):124. doi:10.1186/s12974-016-0590-y.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Maier SF. Bi-directional immune-brain communication: implications for understanding stress, pain, and cognition. Brain Behav Immun. 2003;17(2):69–85.

    Article  CAS  PubMed  Google Scholar 

  120. Guzman A, Tonelli LH, Roberts D, Stiller JW, Jackson MA, Soriano JJ, et al. Mood-worsening with high-pollen-counts and seasonality: a preliminary report. J Affect Disord. 2007;101(1–3):269–74. doi:10.1016/j.jad.2006.11.026.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Postolache TT, Lapidus M, Sander ER, Langenberg P, Hamilton RG, Soriano JJ, et al. Changes in allergy symptoms and depression scores are positively correlated in patients with recurrent mood disorders exposed to seasonal peaks in aeroallergens. Scientific World J. 2007;7:1968–77. doi:10.1100/tsw.2007.286.

    Article  Google Scholar 

  122. Manalai P, Hamilton RG, Langenberg P, Kosisky SE, Lapidus M, Sleemi A, et al. Pollen-specific immunoglobulin E positivity is associated with worsening of depression scores in bipolar disorder patients during high pollen season. Bipolar Disord. 2012;14(1):90–8. doi:10.1111/j.1399-5618.2012.00983.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  123. Postolache TT, Mortensen PB, Tonelli LH, Jiao X, Frangakis C, Soriano JJ, et al. Seasonal spring peaks of suicide in victims with and without prior history of hospitalization for mood disorders. J Affect Disord. 2010;121(1–2):88–93. doi:10.1016/j.jad.2009.05.015.

    Article  PubMed  Google Scholar 

  124. •• Coimbra DG, Pereira ESAC, de Sousa-Rodrigues CF, Barbosa FT, de Siqueira FD, Araujo Santos JL, et al. Do suicide attempts occur more frequently in the spring too? A systematic review and rhythmic analysis. J Affect Disord. 2016;196:125–37. doi:10.1016/j.jad.2016.02.036.

    Article  PubMed  Google Scholar 

  125. Timonen M, Viilo K, Hakko H, Sarkioja T, Meyer-Rochow VB, Vaisanen E, et al. Is seasonality of suicides stronger in victims with hospital-treated atopic disorders? Psychiatry Res. 2004;126(2):167–75. doi:10.1016/j.psychres.2004.02.005.

    Article  PubMed  Google Scholar 

  126. Woo JM, Gibbons RD, Rogers CA, Qin P, Kim JB, Roberts DW, et al. Pollen counts and suicide rates. Association not replicated. Acta Psychiatr Scand. 2012;125(2):168–75. doi:10.1111/j.1600-0447.2011.01813.x.

    Article  CAS  PubMed  Google Scholar 

  127. •• Jeon-Slaughter H, Claassen CA, Khan DA, Mihalakos P, Lee KB, Brown ES. Temporal association between nonfatal self-directed violence and tree and grass pollen counts. J Clin Psychiatry. 2016;77(9):1160–7. doi:10.4088/JCP.15m09864.

    Article  PubMed  Google Scholar 

  128. Messias E, Clarke DE, Goodwin RD. Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication. Acta Psychiatr Scand. 2010;122(2):139–42. doi:10.1111/j.1600-0447.2009.01518.x.

    Article  CAS  PubMed  Google Scholar 

  129. Tonelli LH, Stiller J, Rujescu D, Giegling I, Schneider B, Maurer K, et al. Elevated cytokine expression in the orbitofrontal cortex of victims of suicide. Acta Psychiatr Scand. 2008;117(3):198–206. doi:10.1111/j.1600-0447.2007.01128.x.

    Article  CAS  PubMed  Google Scholar 

  130. Tonelli LH, Katz M, Kovacsics CE, Gould TD, Joppy B, Hoshino A, et al. Allergic rhinitis induces anxiety-like behavior and altered social interaction in rodents. Brain Behav Immun. 2009;23(6):784–93. doi:10.1016/j.bbi.2009.02.017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  131. Woo JM, Gibbons RD, Qin P, Komarow H, Kim JB, Rogers CA, et al. Suicide and prescription rates of intranasal corticosteroids and nonsedating antihistamines for allergic rhinitis: an ecological study. J Clin Psychiatry. 2011;72(10):1423–8. doi:10.4088/JCP.10m06765.

    Article  PubMed  Google Scholar 

  132. Fang BJ, Tonelli LH, Soriano JJ, Postolache TT. Disturbed sleep: linking allergic rhinitis, mood and suicidal behavior. Front Biosci (Schol Ed). 2010;2:30–46.

    Google Scholar 

  133. Kushikata T, Fang J, Wang Y, Krueger JM. Interleukin-4 inhibits spontaneous sleep in rabbits. Am J Phys. 1998;275(4 Pt 2):R1185–91.

    CAS  Google Scholar 

  134. Kushikata T, Fang J, Krueger JM. Interleukin-10 inhibits spontaneous sleep in rabbits. J Interf Cytokine Res. 1999;19(9):1025–30. doi:10.1089/107999099313244.

    Article  CAS  Google Scholar 

  135. Goldstein TR, Bridge JA, Brent DA. Sleep disturbance preceding completed suicide in adolescents. J Consult Clin Psychol. 2008;76(1):84. doi:10.1037/0022-006X.76.1.84.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Bernert RA, Kim JS, Iwata NG, Perlis ML. Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep. 2015;17(3):554. doi:10.1007/s11920-015-0554-4.

    Article  PubMed  Google Scholar 

  137. Davies MJ, Fisher LH, Chegini S, Craig TJ. A practical approach to allergic rhinitis and sleep disturbance management. Allergy Asthma Proc. 2006;27(3):224–30.

    Article  PubMed  Google Scholar 

  138. Craig TJ, Ferguson BJ, Krouse JH. Sleep impairment in allergic rhinitis, rhinosinusitis, and nasal polyposis. Am J Otolaryngol. 2008;29(3):209–17. doi:10.1016/j.amjoto.2007.06.002.

    Article  PubMed  Google Scholar 

  139. Hepner KA, Rowe M, Rost K, Hickey SC, Sherbourne CD, Ford DE, et al. The effect of adherence to practice guidelines on depression outcomes. Ann Intern Med. 2007;147(5):320–9.

    Article  PubMed  Google Scholar 

  140. Association AP. Practise guidelines for the treatment of patients with major depressive disorder 2010. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf.

  141. Israel JA. Remission in depression: definition and initial treatment approaches. J Psychopharmacol. 2006;20(3 Suppl):5–10. doi:10.1177/1359786806064306.

    Article  CAS  PubMed  Google Scholar 

  142. Trivedi MH. Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission. J Clin Psychiatry. 2009;70(Suppl 6):26–31. doi:10.4088/JCP.8133su1c.04.

    Article  PubMed  Google Scholar 

  143. Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC. Diagnostic accuracy of the mood module of the patient health questionnaire: a systematic review. Gen Hosp Psychiatry. 2007;29(5):388–95. doi:10.1016/j.genhosppsych.2007.06.004.

    Article  PubMed  Google Scholar 

  144. Ballard ED, Ionescu DF, Vande Voort JL, Niciu MJ, Richards EM, Luckenbaugh DA, et al. Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety. J Psychiatr Res. 2014;58:161–6. doi:10.1016/j.jpsychires.2014.07.027.

    Article  PubMed  Google Scholar 

  145. Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes TRH, Cipriani A et al. Evidence-based guidelines for treating bipolar disorder: revised third edition. Recommendations from the British Association for Psychopharmacology. J Psychopharmacol (Oxford, England). 2016;30(6):495–553. doi:10.1177/0269881116636545.

  146. Hollon SD, Ponniah K. A review of empirically supported psychological therapies for mood disorders in adults. Depress Anxiety. 2010;27(10):891–932. doi:10.1002/da.20741.

    Article  PubMed  PubMed Central  Google Scholar 

  147. Brown ES, Chandler PA. Mood and cognitive changes during systemic corticosteroid therapy. Prim Care Companion J Clin Psychiatry. 2001;3(1):17–21.

    Article  PubMed  PubMed Central  Google Scholar 

  148. Marchand MS, Jonville-Bera AP, Autret-Leca E. Psychiatric disorders associated with montelukast: data from the National Pharmacovigilance Database. Arch Pediatr. 2013;20(3):269–73. doi:10.1016/j.arcped.2012.12.006.

    Article  PubMed  Google Scholar 

  149. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159(6):909–16. doi:10.1176/appi.ajp.159.6.909.

    Article  PubMed  PubMed Central  Google Scholar 

  150. Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let’s not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412–8. doi:10.1370/afm.719.

    Article  PubMed  PubMed Central  Google Scholar 

  151. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45. doi:10.1056/NEJMsa022615.

    Article  PubMed  Google Scholar 

  152. Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res. 2007;31(2):185–99. doi:10.1111/j.1530-0277.2006.00295.x.

    Article  PubMed  Google Scholar 

  153. Stanley B, Brown GK. Safety planning intervention: a brief intervention to mitigate suicide risk. Cogn Behav Pract. 2012;19:256–64.

    Article  Google Scholar 

  154. Alexopoulos GS, Reynolds 3rd CF, Bruce ML, Katz IR, Raue PJ, Mulsant BH, et al. Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. Cal West Med. 2009;166(8):882–90. doi:10.1176/appi.ajp.2009.08121779.

    Google Scholar 

  155. Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006;166(21):2314–21. doi:10.1001/archinte.166.21.2314.

    Article  PubMed  Google Scholar 

  156. Glied S, Herzog K, Frank R. Review: the net benefits of depression management in primary care. Med Care Res Rev. 2010;67(3):251–74. doi:10.1177/1077558709356357.

    Article  PubMed  Google Scholar 

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Acknowledgements

This article is supported by the Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Tuning Inc., Silver Spring, MD, USA; and the DC Department of Mental Health, St. Elizabeths Hospital Residency Training Program, Washington, DC, USA. Key data presented in this study have resulted from projects supported by R01MH074891 (PI Postolache) from the National Institute of Mental Health, National Institutes of Health, Bethesda, MD. The authors thank Ms. Aline Dagdag and Dr. Naila Karim for their comments on an earlier draft of the manuscript and Ms. Winny Mwaura for her excellent administrative support. The opinions expressed in the article are of the authors and do not represent official positions or views of the National Institutes of Health, or the US Department of Veterans Affairs.

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Authors and Affiliations

  1. Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA

    Ameya U. Amritwar MD, John W. Stiller MD & Teodor T. Postolache MD

  2. Saint Elizabeths Hospital-DBH Psychiatry Residency Training Program, Washington, DC, USA

    Ameya U. Amritwar MD & John W. Stiller MD

  3. Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA

    Christopher A. Lowry Ph. D

  4. Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO, USA

    Christopher A. Lowry Ph. D, Lisa A Brenner Ph. D, Andrew J. Hoisington Ph. D & Teodor T. Postolache MD

  5. Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA

    Christopher A. Lowry Ph. D, Lisa A Brenner Ph. D & Teodor T. Postolache MD

  6. Department of Psychiatry, Physical medicine and Rehabilitation, and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Lisa A Brenner Ph. D

  7. Department of Civil and Environmental Engineering, US Air Force Academy, 2354 Fairchild Dr. Suite 6H-161, Colorado Springs, CO, USA

    Andrew J. Hoisington Ph. D

  8. Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA

    Robert Hamilton Ph. D

  9. VISN 5 Capitol Health Care Network Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA

    Teodor T. Postolache MD

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  1. Ameya U. Amritwar MD
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Correspondence to Teodor T. Postolache MD.

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Conflict of interest

Dr. Christopher A. Lowry is a member of the Scientific Advisory Board of Immodulon Therapeutics, outside of the submitted work. Drs. Ameya U. Amritwar, Lisa A Brenner, Andrew J. Hoisington, Robert Hamilton, John W. Stiller, and Teodor T. Postolache declare that they have no conflict of interest.

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This article does not present any primary data based on human or animal data beyond those previously presented before, appropriately acknowledging human subject and animal rights issues.

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This article is part of the Topical Collection on Allergic Rhinitis

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Amritwar, A.U., Lowry, C.A., Brenner, L.A. et al. Mental Health in Allergic Rhinitis: Depression and Suicidal Behavior. Curr Treat Options Allergy 4, 71–97 (2017). https://doi.org/10.1007/s40521-017-0110-z

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