Importance of Therapeutic Management of Quality of Life among Patients with Atopic Disorders

Introduction

Atopy or atopic disorders is a predisposition to immunological responses against a wide range of allergens that cause hypersensitivity reactions (1). The most common manifestations of atopy include atopic dermatitis, allergic bronchial asthma, allergic rhinitis, and food allergies (1). The effects of these conditions can range from mild and local responses to life-threatening (e.g., anaphylaxis) (2).
Apart from physical impact, atopic disorders have an established relationship with mental health conditions, causing various burdens such as anxiety, depression, and suicidal intentions (2,3,5). As a result, screening for quality of life (QoL), depression, and psychometric approaches are necessary for effective management of patients (7).

Psychological and social consequences of atopic disorders

Clinical evidence suggests an increasing relationship between atopic disorders and mental health conditions (2). Epidemiological studies have shown associations between atopic disorders such as allergic rhinitis and mood disorders, suicidal ideation, anxiety disorders and urticaria with reduced quality of life, depression and anxiety (2).  Comparison between the risk of mental ill-health in patients with atopic disorders and those without shows that the former had 43% more risk of subsequent mental health diagnosis, including OCD, anxiety, or depression, compared to the latter (2). A glimpse of the impact of atopic disorders on mental health among patients is shown in the figure below.

Figure 1: The psychological and social impact of atopic disorders (2-7).
(Abbreviations: QoL: Quality of life, AE: Atopic eczema, HRQoL: Health-related quality of life, MCS:
Mental component score, PCS: Physical component score.)

Age-based impact of atopic disorders

Besides disease severity, patients’ age is also an important factor affecting the QoL of children with atopic disorders, and the treatment and counselling should be tailored specifically to their age (8). Overall, QoL varies by age, with the impact increasing with an increase in age of the patients with atopic disorders (8,9). The varied impact of atopic disorders on quality of life across age groups is illustrated in the figure below.

Figure 2: Age-based difference in impact on quality of life in atopic disorders (4,8-11).
(Abbreviations: QoL: Quality of life, DLQI: Dermatology Life Quality Index, AD: Atopic disorder, IDQOL:
Infant’s Dermatitis Quality of Life Index, CDLQI: Children’s Dermatology Life Quality Index)

Addressing mental health and quality of life in patients with atopic disorders

Due to increased mental ill health disorders among patients with the diagnosis of allergic or atopic disorders, there is a need to consider integrated delivery of allergy and psychology services to optimize the well-being of these patients (2). Screening and assessment for QoL and depression in patients cannot be neglected, and psychometric approaches should be considered for treatment, as shown in the image (13). Simple strategies to address the mental health impact among patients are presented below.

Figure 3: Coping with atopy through various strategies (12, 14-16).
(Abbreviations: AR: Allergic rhinitis, AD: Atopic dermatitis, QoL: Quality of life)

Key takeaways

• The most common atopic disorders, including asthma, atopic dermatitis, allergic rhinitis, etc., have a significant impact on quality of life among patients (1–3,5).
• Health-related QoL varies across patients’ age, with studies showing higher scores for food-related anxiety, emotional impact and social difficulties (8,9).
• Assessment of QoL and other parameters, as well as other strategies like patient education, mindfulness, support groups and psychotherapy, should be considered as a part of patient management (13,15).