Atopic Disorders Linked to Increased Risk of Mental Illness in UK Cohort Study

A recent study saw an increased risk of mental illness among patients from the UK with a diagnosis of allergic or atopic disorders.1

“Consideration of individual atopic and allergic disorders showed that individuals with anaphylaxis exposure had the greatest risk of subsequent mental health diagnosis, with 43% increased risk compared with those without,” wrote investigators, led by Sonica Minhas, from the Institute of Applied Health Research at the University of Birmingham.

Research suggests the relationship between atopic diseases and mental health disorders, with allergic rhinitis linked to mood disorders, suicidal ideation, and anxiety.2,3,4 Some studies also show that urticaria is associated with reduced quality of life and symptoms of depression and anxiety.5 However, most of this research was conducted in small, non-UK Cohorts.

Investigators sought to examine the association between mental illness and allergic and atopic disorders, including food allergy, drug allergy, anaphylaxis, urticaria, and allergic rhino-conjunctivitis.1 The primary outcome of their UK population-based retrospective open cohort study was a composite of mental illness disorders—anxiety, depression, eating disorders, OCD, and self-harm, identified using Read codes. The sample included 2,491,086 individuals who received a primary care recorded atopic disorder between January 1995 and January 2022; diagnoses included food allergy, drug allergy, anaphylaxis, urticaria, allergic rhinoconjunctivitis.

Participants were matched by sex, age (give or take 2 years), and socio-economic deprivation (Townsend quintile score) at index to 3,120,719 controls, although those with atopic disorders were more likely to be female (54.64% vs 49.98%) and White (42.19% vs 35.72%). Among patients with an atopic disorder, the mean age was 39.42 years, compared with a mean age of 35.81 years for controls. The median follow-up period was 5.10 person-years in patients with atopic disorders (IQR, 2.02 – 9.68) vs 4.11 (IQR, 1.59 – 8.37) in patients without atopic disorders.

Among the 2,491,086 individuals diagnosed with an atopic disorder, 229,124 developed a mental health disorder during the study period (incidence ratio [IR] 144.13 per 10,000 person-years). Meanwhile, 203,450 individuals in the control arm developed a mental health disorder (IR, 117.82 per 10,000 person-years).

The analysis showed that, among the mental health disorders, patients with atopic disorders had the greatest risk of anxiety (aHR, 1.22; 95% confidence interval [CI],1.21 – 1.23). Individuals with atopic disorders also had greater risks of depression (aHR, 1.15; 95% CI, 1.14 – 1.16), eating disorders (aHR, 1.06; 95% CI, 1.01 – 1.11), OCD (aHR, 1.20; 95% CI, 1.14 – 1.26), and self-harm (aHR, 1.02; 95% CI, 1.00 – 1.04). The study showed no difference in the risk of severe mental illness between patients with and without atopic disorders (aHR, 0.99; 9% CI, 0.95 – 1.03).

Investigators found all atopic disorders were linked to a greater risk of mental illness compared with those without atopic disorders: food allergy (aHR, 1.07; 95% CI, 1.03 – 1.11), drug allergy (aHR, 1.28; 95% CI, 1.27 – 1.29), anaphylaxis (aHR, 1.43; 95% CI, 1.32 to 1.54), urticaria (aHR, 1.15; 95% CI, 1.14 – 1.17), and allergic rhinitis (aHR, 1.12; 95% CI, 1.12 – 1.14).

“Notably, our results demonstrated that food allergy and drug allergy exposure were associated with increased risk of all mental health outcomes,” investigators wrote.

Patients with anaphylaxis had the greatest risk of anxiety (aHR, 1.59; 95% CI, 1.41 – 1.79), OCD (aHR, 2.37; 95% CI, 1.28 – 4.40), and depression (aHR, 1.36; 95% CI, 1.23 – 1.50).

The sensitivity analyses showed similar results as the other findings, demonstrating an increased risk of all mental illness outcomes in patients with atopic disorders compared with those without (aHR, 1.16; 95% CI, 1.15 – 1.16). The risk of all mental health outcomes increased for ); anxiety (aHR, 1.21; 95% CI, 1.20 – 1.23); depression (aHR, 1.15; 95% CI, 1.14 – 1.16); eating disorders (aHR, 1.06; 95% CI, 1.01 – 1.10); OCD (aHR, 1.18; 95% CI, 1.13 – 1.24); self-harm (aHR, 1.03; 95% CI, 1.01 – 1.05); only severe mental illness did not have an increased risk (aHR, 0.99; 95% CI, 0.96 – 1.03).

“Analysis of each individual mental health outcome showed a positive association with atopy exposure, except [severe mental illness],” investigators wrote. “These findings were robust to a sensitivity analysis, suggesting that the impact was related to atopy rather than eczema or asthma.”

References

1. Minhas S, Chandan JS, Knibb R, Diwakar L, Adderley N. Association between atopic disorders and mental ill health: a UK-based retrospective cohort study. BMJ Open. 2025;15(5):e089181. Published 2025 May 31. doi:10.1136/bmjopen-2024-089181

2. Oh H, Koyanagi A, DeVylder JE, et al. Seasonal allergies and psychiatric disorders in the United States. Int J Environ Res Public Health 2018;15:1965. doi:10.3390/ijerph1509196

3. Messias E, Clarke DE, Goodwin RD. Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication. Acta Psychiatr Scand. 2010;122(2):139-142. doi:10.1111/j.1600-0447.2009.01518.x

4. Patten SB, Williams JV. Self-reported allergies and their relationship to several Axis I disorders in a community sample. Int J Psychiatry Med. 2007;37(1):11-22. doi:10.2190/L811-0738-10NG-7157

5. Tawil S, Irani C, Kfoury R, et al. Association of chronic urticaria with psychological distress: a multicentre cross-sectional study. Acta Derm Venereol 2023;103:2939. doi:10.2340/actadv.v102.2939