Allergy: a risk factor for suicide?
Allergy: a risk factor for suicide?
复制标题
DOI：
10.1007/s11940-008-0039-4
复制
发表时间：
2008-09
影响因子：
2
通讯作者：
Tonelli, Leonardo H
中科院分区：
文献类型：
--
作者：
Postolache, Teodor T;Komarow, Hirsh;Tonelli, Leonardo H
过敏性鼻炎患者的抑郁、焦虑和睡眠障碍（自杀危险因素）发生率高于一般人群。抑郁症患者的过敏率也更高。初步数据表明，有过敏史的患者自杀率可能更高。临床医生应积极询问诊断过敏性抑郁症患者和过敏性抑郁症患者。春季自杀高峰被高度重复，但其起源却知之甚少。初步流行病学数据表明，空气过敏原的季节性春季高峰与自杀的季节性高峰相关。我们对棕色挪威大鼠的研究表明，致敏和接触空气过敏原会诱发焦虑样和攻击性行为，以及前额皮质中与过敏相关的 2 型辅助 T 细胞 (Th2) 细胞因子基因表达。因此，过敏和接触空气过敏原（在春季达到高峰）可能会导致焦虑、抑郁、敌意/攻击性和睡眠障碍等自杀危险因素的季节性恶化。将过敏与自杀和自杀危险因素联系起来，增加了先前将过敏与偏头痛和癫痫症联系起来的神经病学文献。我们最近关于自杀受害者眶额皮质中 Th2（过敏介导）细胞因子表达的报告应该会引发未来的研究，以检验鼻腔过敏性炎症介质可能导致大脑中 Th2 细胞因子表达，影响情感和行为调节的假设。某些用于治疗过敏的药物可能会加剧自杀风险因素，可能会加剧自杀风险，甚至引发自杀。全身（但非局部）皮质类固醇与躁狂和抑郁发作以及混合情绪状态有关。最近，美国食品和药物管理局开始调查孟鲁司特可能引发自杀的可能性。尽管这种关联需要进一步的探索和确认，但临床医生应该谨慎行事，询问过去的自杀企图；绝望;生活的理由；自杀意念、意图或计划；如果合适，将患者转介给心理健康专业人士进行评估。
The rates of depression, anxiety, and sleep disturbance (suicide risk factors) are greater in patients with allergic rhinitis than in the general population. The rate of allergy is also greater in patients with depression. Preliminary data suggest that patients with a history of allergy may have an increased rate of suicide. Clinicians should actively inquire to diagnose allergy in patients with depression and depression in patients with allergy. Spring peaks of suicide are highly replicated, but their origin is poorly understood. Preliminary epidemiologic data suggest that seasonal spring peaks in aeroallergens are associated with seasonal spring peaks in suicide. Our research in Brown Norway rats demonstrates that sensitization and exposure to aeroallergens induces anxiety-like and aggressive behaviors as well as allergy-related helper T-cell type 2 (Th2) cytokine gene expression in the prefrontal cortex. Thus, it is possible that sensitization and exposure to aeroallergens, which peak in spring, may be conducive to seasonal exacerbation of suicide risk factors such as anxiety, depression, hostility/ aggression, and sleep disturbance. Connecting allergy with suicide and suicide risk factors adds to previous neurologic literature connecting allergy with migraines and seizure disorders. Our recent report of Th2 (allergy-mediating) cytokine expression in the orbito-frontal cortex of suicide victims should lead to future studies to test the hypothesis that mediators of allergic inflammation in the nasal cavities may result in Th2 cytokine expression in the brain, influencing affect and behavioral modulation. Certain medications used to treat allergy can exacerbate suicide risk factors, potentially worsening suicide risk and even triggering suicide. Systemic (but not topical) corticosteroids have been associated with manic and depressive episodes and mixed mood states. Recently, the US Food and Drug Administration started investigating the possibility that montelukast may trigger suicide. Although this association requires further exploration and confirmation, clinicians should err on the side of caution, inquiring about past suicide attempts; hopelessness; reasons for living; and suicidal ideation, intent, or plan; and referring the patient to a mental health professional for evaluation if appropriate.