Akkoca Y; Kenar F; Inci Kenar AN; Karabulut H

Research Article

Austin J Allergy. 2016; 3(1): 1023.

Is there a Relationship between Social Support a High Histamine in Allergic-Non Allergic Rhinitis?

Akkoca Y¹*, Kenar F², Inci Kenar AN³ a Karabulut H

¹Department of Psychiatry, Ankara Training a Research Hospital, Turkey

²Department of ENT, Faculty of Medicine, Pamukkale University, Turkey

³Department of Psychiatry, Faculty of Medicine, Pamukkale University, Turkey

⁴Department of ENT, Faculty of Medicine, Gazi University, Turkey

*Correspoing author: Yasemin Akkoca, Department of Psychiatry, Ankara Training a Research Hospital, Ankara, Turkey

Received: October 26, 2016; Accepted: November 30, 2016; Published: December 01, 2016

Abstract

Backgrou: The histaminergic system has been shown to be important for emotional state, anxiety, allergy, a the brain arousal system. In this study, we aimed to investigate the relationship between social support a high histamine in patients with Allergic-Non allergic Rhinitis (AR-NAR).

Methods: Diagnosis of AR was made using the fiings of physical a nasal eoscopic examination a the results of the skin prick test. Of 131 patients, 90 were diagnosed as having AR, a 41 as having NAR. Competence of social support of all patients was assessed using the Multidimensional Scale of Perceived Social Support.

Results: Allergic patients aged less than 40 years a women who were allergic had higher scores in the “Perceived Family Support Subscale” (PFSS) than patients with NAR. We also fou increased scores of PFSS, special a social support total scores in male patients with NAR than in female patients with NAR.

Conclusion: Although patients with AR a NAR have similar symptoms, our results show that patients who are allergic have increased social ability. These results can explain which allergic patients have high histamine. In accordance with our results, we fou that patients who were depressive a/ or anxious had social introversion, a increased histamine in the brain reduced social introversion, as well as depressive a anxiety symptoms.

Keywords: Allergic rhinitis; Social support; Family support; Skin prick test; Multidimensional scale of perceived social support

Introduction

Rhinitis is defined as an inflammation of the nasal mucosa. A high number of patients experience Allergic Rhinitis (AR) between the ages of 20-40 years [1,2]. It has clinical symptoms such as excessive mucus production, watery eyes, congestion, paroxysmal sneezing, a nasal a ocular pruritus. AR is considered a systemic disease a may be associated with constitutional symptoms such as fatigue, malaise, a headache. The most common diagnostic test for AR is the Skin Prick Test (SPT) [3]. The diagnosis of Non-Allergic Rhinitis (NAR) is made with no determining allergic or IgE-mediated causes. Acute viral infection is the most common cause of NAR. Less common chronic causes include vasomotor rhinitis, hormonal rhinitis, a NAR with eosinophilia syrome. The epidemiology a diagnostic criteria of NAR are confusing [4]. Patients with NAR can have local production of IgE antibodies a are therefore considered allergic. This concept has been defined as “entopy’’ or “local AR’’ [5,6].

The symptoms of AR have negative effects on emotional, physical, a social functioning, a lead to concentration difficulties at home, school a work, in addition to reduced productivity. This may result in decreased health-related quality of life [7]. Although the symptoms of the patients with AR a NAR are similar, it was fou that patients with NAR have higher depressive, fatigue, social introversion, a decreased life activity than patients with AR [4]. These differences may be related with some immune mediators such as histamine. The aim of this study was to investigate the relationship between social support a high histamine in patients with AR-NAR.

Materials a Methods

Patients with a pre-diagnosis of AR who had been followed up with an allergy test in the department of otorhinolaryngology were included into the study. The protocol for the research project was coucted in accordance with the principles of the Helsinki Declaration a approved by the Local Institutional Review Board a Ethics Committee. The files of 1700 patients who uerwent an allergy test with a pre-diagnosis of AR were reviewed, a 131 files in which the Multidimensional Scale of Perceived Social Support (MSPSS) was completed were retrospectively analyzed.

The diagnosis of AR was made using the fiings of physical a nasal eoscopic examinations a the results of the SPT. Runny a itchy nose, sneezing, nasal obstruction, presence of serous secretion in the nasal cavity, pale nasal mucosa, edema, a pale or purplish conchae were considered as AR. Patients were evaluated in regards of dermatologic signs such as urticaria, eruption, itching, a erythema. Pulmonary symptoms such as cough, wheezing a dyspnea, a ocular symptoms such as redness, itching, a edema were also questioned.

Instruments

Skin Prick test: Alyostal ST-IR (Stallergenes S.A., Antony Cedex,. France) staard allergen extracts were used for the SPT. Before the test, antihistaminic drugs were withdrawn for 10 days, antidepressants for 20 days, a H2 receptor blockers were withdrawn for 24 h. Allergen extracts were taken in staard doses in quick test applicators with 8 distinct edges were applied onto the skin after having cleaned the ventral part of the forearm with alcohol. The results were checked 15 min later. Histamine-HCl was used as positive control a isotonic NaCl was used as negative control. The validity criteria for the test were accepted as >3 mm for the positive control a <3 mm for the negative control. A skin reaction against the allergen with an iuration of >3 mm in diameter was accepted as a positive reaction [8].

The most common 30 allergen extracts a positive a negative controls were applied using a total of 4 applicators onto the skin of the forearm for the SPT. Fifteen pollens, 6 food allergens, 3 animal epithelia, 3 fungal spores, 2 house dust mites, a 1 insect were used.

The SPT was not applied to patients who were uer treatment for asthma, those who were suspected of having asthma, or patients being treated with beta-blocker drugs.

The Multidimensional Scale of Perceived Social Support (MSPSS): This scale is a short, practical scale that subjectively assesses the competence of social support. With the recommeed subscale structure, the MSPSS scale contains a total of 12 questions about the support accepted from family, fries or specific persons. Each item is rated using a scale with seven intervals. Higher scores mean that the perceived social support is high [9]. The MSPSS is used to determine the perception of iividuals’ social support sufficiency. Factor analysis of MSPSS showed three subscales: family, fries, a significant others. The response format is based on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree). Scores from iividual items are averaged in each scale a the total scale. The range is 12-84. Cronbach’s coefficient alpha ranged from 0.85 to 0.91 on iividual a total scales. This scale was adapted into Turkish by Eker et al. (2001) showing good reliability a validity in Turkish samples [9]. The overall Cronbach alpha reliability of the scale was fou as 0.83. Test-retest reliability for the total scale was 0.85, ranging from 0.72 to 0.85 on the subscales [10].

Statistical analysis

Data were analyzed using the Statistical Package for the Social Sciences for Wiows version 15.0 (SPSS Inc., Chicago, IL). After coucting factor analyses for the MSPSS, a correlation matrix was created to examine the correlations between variables a to determine which variables would be used as iepeent variables in the regression analyses. Student’s t-test was used to assess relationships among the demographic variables a perceived social support scores. Two-way ANOVA a post-hoc analysis were used for comparisons between intergroup variables (sex, age, allergic a non-allergic groups). A p value of < 0.05 was accepted as statistically significant for all tests.

Results

The mean age of the patients was 33.2±12.3 years (range, 16-61 years); 92 (70.2%) were female a 39 (29.8%) were male. The mean age of the females was 32.3±11.7 years a mean age of the males was 35.3±13.5 years; there was no significant difference between the sexes (p>0.05). Of the 131 patients, 90 were diagnosed as having AR, a 41 as having NAR using SPT results. The distribution of patients with AR a NAR according to age a sex is shown in Table 1.

Table 1: Demographic Variables.




  
     
    Allergic Rhinitis (n=90) 
    Non-allergic Rhinitis (n=41) 
  
  
    n (%)
    n (%)
  
  
    Age
    =40 
    65 (72.2) 
    29 (70.7) 
  
  
    >40 
    25 (27.8) 
    12 (29.3) 
  
  
    Geer
    Female
    70 (77.8) 
    22 (53.7) 
  
  
    Male
    20 (22.2) 
    19 (46.3)



Table 1:  Demographic Variables.

When Student’s t-test was used to assess the patients who presented with symptoms of rhinitis, no significant difference was fou between patients with positive a negative SPT results a sexes in terms of MSPSS a subscales (p>0.05) is shown in Table 2.

Table 2: The Multidimensional Scale of Perceived Social Support results of groups.




  
    
    Sex
    
    Prick test
    
  
  
    
    Female    (n=92) Mean±SD 
    Male (n=39) Mean±SD 
    p^* 
    Positive    (n=90) Mean±SD 
    Negative    (n=41) Mean±SD 
    p^* 
  
  
    Significant    others 
    19.8±8.7 
    22.6±7.2 
    <0.08 
    20.5±8.3 
    20.7±8.6 
    <0.90 
  
  
    Family 
    22.6±7.1 
    22.6±7.4 
    <0.97 
    23.1±6.4 
    21.4±8.7 
    <0.20 
  
  
    Fries 
    19.5±8.1 
    20.1±7.9 
    <0.66 
    20.0±8.1 
    19.0±7.8 
    <0.50 
  
  
    SSTS^† 
    62.1±20.5 
    65.2±18.1 
    <0.41 
    63.7±18.6 
    61.6±22.5 
    <0.57 
  
  
    ^*Student’s t-test was performed. A p    value of <0.05 was accepted statistically significant.
      ^†SSTS: Social Support Total Score.



Table 2:  The Multidimensional Scale of Perceived Social Support results of groups.

The MSPSS scores of patients with negative a positive SPT results are presented in Table 3. When the decades of patient’s age with AR a NAR groups were compared, a significant difference was fou between patients aged uer a over 40 years in parameters of the MSPSS (Table 3). These results iicated that scores of Perceived Family Support Subscale (PFSS) of patients with AR aged uer 40 years were significantly higher than those of patients with NAR aged uer 40 years (p=0.007). Further, scores of PFSS (p=0.005) a social support total scores (SSTS) (p=0.05) were higher in patients with AR aged uer 40 years than those of patients aged over 40 years in the AR group. In male patients with NAR, scores of SSTS, PFSS, a the special subscale were fou statistically significantly higher than in females with NAR (p=0.040, p=0.043, a p=0.043, respectively). Moreover, scores of PFSS were significantly higher in female patients with AR than in female patients who were non-allergic (p=0.013).

Table 3: Comparisons between the multidimensional scales of perceived social supports cores with age group, geer in allergic a non-allergic groups.




  
     
    Allergic group(AR)
    Non-allergic group(NAR) 
     
     
     
     
  
  
     
    Female (n=70)
      Mean±SD
    Male (n=20) Mean±SD
    Female (n=22) Mean±SD
    Male (n=19) Mean±SD
    df
    F
    p
    Sources of differences
  
  
    Significantothers
    20.2±8.6
    21.6±7.1
    18.3±9.1
    23.6±7.3
    1
    1.57
    <0.213
     
  
  
    Family
    23.7±6.1
    21.4±7.3
    19.3±9.2
    23.8±7.4
    1
    9.08
    <0.003^*
    F†AR-FNAR, FNAR-M‡NAR
  
  
    Fries
    20.3±7.9
    19.0±8.9
    16.9±8.4
    21.4±6.6
    1
    4.54
    <0.035^*
    FNAR-MNAR
  
  
    SSTS
    64.1±18
    62.2±17
    55.7±24.3
    68.5±18.5
    1
    5.27
    <0.023^*
    FNAR-MNAR
  
  
     
    Allergic group
    Non-allergic group
     
     
     
     
  
  
     
    =40 years(n=65) Mean±SD
    >40years (n=25) Mean±SD
    =40 years(n=29) Mean±SD
    >40years(n=12) Mean±SD
    df
    F
    p
    Sources of differences
  
  
    Significantothers
    20.9±8.1
    9.5±8.7
    20.1±9.1
    22.3±6.3
    1
    0.83
    <0.365
     
  
  
    Family
    24.4±4.7
    19.8±8.8
    20.2±9.2
    24.3±6.8
    1
    10.99
    <0.001^*
    =40AR-=40NAR,=40AR->40AR
  
  
    Fries
    20.9±7.7
    17.6±8.7
    18.7±8.3
    19.6±7.0
    1
    2.07
    <0.152
     
  
  
    SSTS§
    66.1±16.7
    57.3±21.8
    59.5±24.7
    66.8±15.5
    1
    4.60
    <0.034^*
    =40AR- >40AR
  
  
    ^*A p value of <0.05 was accepted    statistically significant.
      ^†F: Female; ‡M: Male; §SSTS: Social    support total score



Table 3:  Comparisons between the multidimensional scales of perceived social supports cores with age group, geer in allergic a non-allergic groups.

Discussion

In this study, we examined the relationships between social ability a patients with AR-NAR in terms of high histamine. The results showed that young patients a women who were allergic had more family support than patients with NAR. Additionally, increased family support, special, a general social support were fou in male than female patients with NAR. Although patients with AR a NAR had similar symptoms, family support was higher among patients who were allergic. These results may iicate that patients who are allergic have more affiliative or social behavior.

The psychiatric a social factors are important for the management of allergic diseases. Previous studies reported that patients who were allergic teed to have increased negative mood, social introversion, a anxiety than healthy controls [11]. Furthermore, Roo´n et al. fou that 64% of patients with NAR reported moderate-to-severe rhinitis affected their quality of life [12]. Few studies have investigated the relation between patients with AR a NAR. In accordance with our results, Ryden et al. reported that 53% of patients with NAR a 33% of those with AR said that their social life a family relationships were limited due to their symptoms [4]. The symptoms of patients with AR a NAR are similar before rhinitis attacks a related impairment of social ability [12]. This difference may be due to the allergic reactions.

Allergic rhinitis is an inflammatory disease related with type I hypersensitivity reaction. This IgE-mediated reaction iuces mast cell degranulation a results in the development of an inflammation by release of histamine, leukotriene, prostaglain, a plateletactivating factor [13], whereas it was explained that NAR is local inflammation a includes confuse reactions [6]. The most important difference between these two diseases seems to be the histamine mediator. A positive SPT shows higher histamine levels in patients with AR than in patients who are non-allergic [3].

This diversity can be related with high histamine or patients with productive histadelia. A high level of blood histamine is called histadelia. The sypmtoms of histadelia include high academic achievement, perfectionism, high self esteem, obsession a compulsion, less than average need for sleep, overstimulation with productivity, a frequent allergic reactions [14,15]. As a result, we speculate that high histamine is protective for patients with AR in terms of social ability a depression [14].

We fou no information on the direct social effects of histamine; however, it was reported that there was a relationship between histamine a oxytocin mediators in the brain. Affiliative human behavior was associated with mediators such as oxytocin, vasopressin, a serotonin [16]. Serotonin can iuce oxytocin neurons via 5-HT1A, 5-HT2A, a 5-HT2c receptors. The release of oxytocin is also regulated via histamine, glutamate, opioids, a dopamine [17]. Furthermore, histamine is also involved in the process of arousalrelated systems including sex behaviors a anxiety [18]. These results show that histamine can have effects on social family boing iirectly with oxytocin a the other social behaviors such as sex behaviors.

Previous studies reported that patients who were allergic were highly anxious a more sensitive to stress [19]. Anxiety disorders could be important in terms of a possible relationship with affiliative behavior towards family. The fact that some people have fewer social contacts than others may reflect attributes of temperament or personality that have negative emotions (e.g., anxiety, anger), or that hier sociality, such as social anxiety or shyness. These two personality characteristics, negative affectivity a inhibited sociality, affect both quality of social support a social networks [20].

Brain histaminergic systems may be concerned with psychological state a memory processes [21,22]. Histamine receptors are classified in 4 subtypes; H1, H2, H3 a H4 [23]. The H3 receptor is a presynaptic auto-receptor that inhibits neurotransmitter release from histaminergic a non-histaminergic terminals, a reduces cell firing a histamine synthesis in histaminergic neurons [24].

Evidence supporting a role for the histaminergic system in social memory came from many studies that demonstrated that administration of histamine facilitated social memory in rats [25,26]. Social recognition includes memory retention in rats, in which an adult animal uses olfactory signs to remember a social interaction with a conspecific juvenile [27]. It is likely that the observed recovery of recognition memory with H3 receptor antagonists used in recent studies reports into improved social memory a cognition in patients [28,29,30]. Researchers showed that there was a relationship between impaired social memory a the reduction H3 receptors in the hippocampal CA2 region (all 19). New H3R antagonists have been reported to have antidepressant-like effects a reduced anxiety-like behaviors in rats [31,32]. Further, it was fou that mast cell-deficient mice had significant anxiety-like behaviors [33]. Histamine H3R antagonists can regulate the release of different neurotransmitters a have iicated both antidepressant a pro-cognitive effects in animal experiments [25,34]. Histamine regulates cognitive functions including motivation, arousal, learning a memory processes, a autonomic functions (sleep/wake cycle, thermoregulation, a food intake) [23]. Many of these processes are disrupted in depression, which is characterized by a lack of motivational drive, distractibility, deficit in episodic memory, insomnia or hypersomnia, reduced body weight or increased food intake. Impairment of histamine regulation can also cause social introversion [35]. These results support our hypothesis that high histamine increases sociability in human.

The results of this study showed that male patients with NAR had higher scores of PFSS, special subscale, a SSTS than female patients with NAR. This situation can be related with the fact that in the Turkish population men are more important for family, especially for their mothers, in terms of economic status, social position, a having the right to speak [36]. This result can also show that women with AR have relatively more social abilities than patients with NAR.

In the present study, it was also observed that scores of PFSS a SSTS were increased in patients with AR aged less than forty years than those aged over forty. Although there are no satisfactory data about this topic, these results may suggest that strong Turkish family ties weaken as age increases. In accordance with our results, it was shown that social support decreases as age increases [37]. Contrarily, it was reported that social support levels for older patients were higher than those for young patients, a scores of the family subscale were significantly higher with obstructive sleep apnea syrome [38]. It was explained that AR is more frequent between the ages of 20-40 years [1]. This coition can be related with more active histamine in the mentioned age ranges. In a large population a Swiss study reported that allergen-specific Ig E a allergic illness decreased by 23% a 21% with every 10-year increase in age [39]. Furthermore, the prevalence of AR showed a significant desceing pattern as 26.6%, 20.6%, a 15.6% at ages of 20-44 years, 45-64 years, a 65- 84 years, respectively [40]. These results support why there is high PFSS score in young adults with AR. In accordance with our results, recent researchs reported that AR incidence increased in female patients who were allergic [41,42]. On the other ha, histamine could be higher in women than in men.

The limitations of the study are as follows: no evaluation of psychiatric illness a personality properties of patients AR a NAR were coucted, a the absence of the familial history of AR was not investigated.

Conclusions

Young patients who are allergic with increased social ability caused by AR have high histamine. Patients with depressive a/or anxiety had social introversion a studies reported that increased histamine in the brain reduced social introversion, as well as depressive a anxiety symptoms. We speculate that high histamine can positively affect the social behavior of patients with AR. Our argument will be supported by further studies, which should simultaneously evaluate blood histamine a oxythosine. More studies are needed to determine the effect of the brain histaminergic system on human social behavior.

References

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Citation: Akkoca Y, Kenar F, Inci Kenar AN a Karabulut H. Is there a Relationship between Social Support a High Histamine in Allergic-Non Allergic Rhinitis?. Austin J Allergy. 2016; 3(1): 1023. ISSN:2378-6655

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