The finding:
This systematic review and meta-analysis represent a significant advancement in our understanding of the psychological burden in patients with allergic rhinitis (AR), especially its significant negative impact on mood, sleep, anxiety. Notably, this study found that patients with AR have a 14% prevalence rate for suicidal thoughts and 4% for suicide attempts, significantly higher than the general population. The specific link between AR and suicide has not been studied much, making these findings noteworthy. The authors speculate that the chronicity of distressing symptoms in AR, the negative impact on sleep and mood and the consequent impact on quality of life are likely explanations of the higher suicide risk in these patients.

Strength and weaknesses:
This study’s strength’s include a large sample size from 49 studies from 5 different countries. Both adult and adolescent populations were considered, though mostly comprised of adults.  Limitations include a high heterogeneity of results that suggest the possibility of unmeasured factors such as genetic predispositions, lifestyle factors, or concurrent health conditions influencing the observed associations. Second, longitudinal studies are needed to establish the directionality and causality in the AR-mental health relationship. Third, the lack of relevant data made it impossible to examine the effect-modifying role of various factors, for eg: duration (seasonal vs. perennial AR), AR severity (mild vs. moderate vs. severe), and COVID-19 pandemic on studied mental health problems. Finally, future research investigating the potential beneficial impact of surgery on the psychological wellbeing of those patients was not studied here.

Relevance:
Allergic Rhinitis (Hay Fever) has a high global prevalence and affects approximately 10–30% of the adult population and up to 40% of children, with industrialized countries showing higher rates. Despite being often regarded as a minor ailment, the impact of allergic rhinitis on individuals’ lives is far from trivial. CL psychiatrists are uniquely positioned to screen, diagnose and initiate treatment for the heavy burden of psychiatric symptoms (anxiety, depression, insomnia, suicidal ideation and attempts) carried by patients with AR.