Abstract

Background
Psychological stress can affect airway inflammatory response to irritants and allergens, but the importance of stress in the etiology of adult-onset respiratory and dermatologic allergic disorders remains unclear. We aim to address the relationship between perceived stress and the risk of adult-onset asthma, allergic rhinitis, atopic dermatitis, and asthma/bronchitis medication.

Methods
Participants (n = 9785) from the Copenhagen City Heart Study, Denmark, free of atopic disorders at baseline in 1981–1983 were asked questions on stress intensity and frequency. They were followed for first-time asthma hospitalization in nationwide registers until 2010, with < 0.1% loss to follow-up. Objective measures of lung function allowed for thorough adjustment for confounding and prevented ambiguity between diagnosis of asthma and chronic obstructive lung disease. Daily intake of asthma/bronchitis medication and incidence of asthma, allergic rhinitis, and atopic dermatitis were assessed by self-report after 10 years of follow-up in 5648 persons.


Results
Perceived stress was associated with atopic disorders in a dose-dependent manner (Ptrend < 0.001). High vs low stress was associated with higher risk of self-reported asthma incidence (OR = 2.32; 95% CI: 1.47–3.65), daily intake of asthma/bronchitis medication (OR = 2.26; 95% CI: 1.42–3.58), first-time asthma hospitalization (HR = 2.01; 95% CI: 1.41–2.86), allergic rhinitis (OR = 1.64; 95% CI: 0.99–2.72), and atopic dermatitis (OR = 1.75; 95% CI: 1.11–2.77). The associations were similar for smokers and nonsmokers.

Conclusions
Stress is strongly associated with asthma incidence and hospitalization, use of asthma medication as well as with allergic rhinitis and atopic dermatitis in adults.

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