An Occurence of Oral Allergic Reactions in Patients with Illnes Anxiety Disorder
An Imaginary Illness Turns into Real Lesions
Abstract
Background Allergic reaction affects up to 30% of the world’s population, with underlying pathophysiology involving immunoregulatory dysfunctions and the most common oral symptom is ulceration. Case Description A 33-year-old male patient did doctor shopping of Oral Medicine Specialists in Jakarta with the fear of having oral cancer and was diagnosed of hypochondriasis by psychiatrist. The patient noticed a small irregular red macule on the palate that grew wider every day. There was no pain, bleeding or migration of lesion reported. Hematology profile showed an increased level of Immunoglobulin E (IgE). The red macule completely resolved after administration of Loratadine 10 mg once daily for a month. The patient was educated for routine oral check-up and psychiatry consultation. Conclusion Hypochondriasis may cause immunoregulatory imbalance by modulating Th2 cytokines system that is responsible in IgE level and may produce the unspecific oral manifestation which gave positive response with antihistamine drug.References
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2. Kader Maideen SF, Mohd Sidik S, Rampal L, Mukhtar F. Prevalence, associated factors and predictors of anxiety: a community survey in Selangor, Malaysia. BMC Psychiatry. 2015;15(1):262. doi:10.1186/s12888-015-0648-x
3. Martin-Merino E, Ruigomez A, Wallander MA, Johansson S, Garcia-Rodriguez LA. Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care. Fam Pract. 2010;27(1):9-16. doi:10.1093/fampra/cmp071
4. Baumeister H, Härter M. Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol. 2007;42(7):537-546. doi:10.1007/s00127-007-0204-1
5. Strine TW, Mokdad AH, Balluz LS, et al. Depression and Anxiety in the United States: Findings From the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv. 2008;59(12):1383-1390. doi:10.1176/ps.2008.59.12.1383
6. Baxter AJ, Vos T, Scott KM, et al. The regional distribution of anxiety disorders: implications for the Global Burden of Disease Study, 2010: The Regional Distribution of Anxiety Disorders. Int J Methods Psychiatr Res. 2014;23(4):422-438. doi:10.1002/mpr.1444
7. Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys. Epidemiol Psichiatr Soc. 2009;18(1):23-33. doi:10.1017/S1121189X00001421
8. Grossi D, Longarzo M, Quarantelli M, et al. Altered functional connectivity of interoception in illness anxiety disorder. Cortex. 2017;86:22-32. doi:10.1016/j.cortex.2016.10.018
9. Johansen T. Illness Anxiety Disorder: A Proposed Adlerian Formulation. J Individ Psychol. 2018;74(2):229-237. doi:10.1353/jip.2018.0014
10. Marcus DK, Gurley JR, Marchi MM, Bauer C. Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clin Psychol Rev. 2007;27(2):127-139. doi:10.1016/j.cpr.2006.09.003
11. Gregory E. Simon, Michael VonKorff. Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area study. Am J Psychiatry. 1991;148(11):1494-1500. doi:10.1176/ajp.148.11.1494
12. Marciniak MD, Lage MJ, Dunayevich E, et al. The cost of treating anxiety: the medical and demographic correlates that impact total medical costs. Depress Anxiety. 2005;21(4):178-184. doi:10.1002/da.20074
13. Katon W, Lin EHB, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29(2):147-155. doi:10.1016/j.genhosppsych.2006.11.005
14. Walker EA, Katon W, Russo J, Ciechanowski P, Newman E, Wagner AW. Health Care Costs Associated With Posttraumatic Stress Disorder Symptoms in Women. Arch Gen Psychiatry. 2003;60(4):369. doi:10.1001/archpsyc.60.4.369
15. Sareen J, Cox BJ, Clara I, Asmundson GJG. The relationship between anxiety disorders and physical disorders in the U.S. National Comorbidity Survey. Depress Anxiety. 2005;21(4):193-202. doi:10.1002/da.20072
16. Ludman E, Katon W, Russo J, et al. Panic episodes among patients with diabetes. Gen Hosp Psychiatry. 2006;28(6):475-481. doi:10.1016/j.genhosppsych.2006.08.004
17. Harter MC, Conway KP, Merikangas KR. Associations between anxiety disorders and physical illness. Eur Arch Psychiatry Clin Neurosci. 2003;253(6):313-320. doi:10.1007/s00406-003-0449-y
18. Sareen J, Jacobi F, Cox BJ, Belik SL, Clara I, Stein MB. Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions. Arch Intern Med. 2006;166(19):2109. doi:10.1001/archinte.166.19.2109
19. Gregory AM, Caspi A, Moffitt TE, Milne BJ, Poulton R, Sears MR. Links Between Anxiety and Allergies: Psychobiological Reality or Possible Methodological Bias? J Pers. 2009;77(2):347-362. doi:10.1111/j.1467-6494.2008.00550.x
20. Dave ND, Xiang L, Rehm KE, Marshall GD. Stress and Allergic Diseases. Immunol Allergy Clin North Am. 2011;31(1):55-68. doi:10.1016/j.iac.2010.09.009
21. Seizer L, Schubert C. On the Role of Psychoneuroimmunology in Oral Medicine. Int Dent J. 2022;72(6):765-772. doi:10.1016/j.identj.2022.07.002
22. Vitlic A, Lord JM, Phillips AC. Stress, ageing and their influence on functional, cellular and molecular aspects of the immune system. AGE. 2014;36(3):9631. doi:10.1007/s11357-014-9631-6
23. Lin TK, Zhong L, Santiago J. Association between Stress and the HPA Axis in the Atopic Dermatitis. Int J Mol Sci. 2017;18(10):2131. doi:10.3390/ijms18102131
24. van den Heuvel OA, Veale D, Stein DJ. Hypochondriasis: considerations for ICD-11. Rev Bras Psiquiatr. 2014;36(suppl 1):21-27. doi:10.1590/1516-4446-2013-1218
25. Newby JM, Hobbs MJ, Mahoney AEJ, Wong S (Kelvin), Andrews G. DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. J Psychosom Res. 2017;101:31-37. doi:10.1016/j.jpsychores.2017.07.010
26. Scarella TM, Boland RJ, Barsky AJ. Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment. Psychosom Med. 2019;81(5):398-407. doi:10.1097/PSY.0000000000000691
27. Kessler RC, Ormel J, Demler O, Stang PE. Comorbid Mental Disorders Account for the Role Impairment of Commonly Occurring Chronic Physical Disorders: Results From the National Comorbidity Survey: J Occup Environ Med. 2003;45(12):1257-1266. doi:10.1097/01.jom.0000100000.70011.bb
28. Wang PS, Beck AL, Berglund P, et al. Effects of Major Depression on Moment-in-Time Work Performance. Am J Psychiatry. 2004;161(10):1885-1891. doi:10.1176/ajp.161.10.1885
29. Heffner KL, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Marshall GD. Stress and anxiety effects on positive skin test responses in young adults with allergic rhinitis. Ann Allergy Asthma Immunol. 2014;113(1):13-18. doi:10.1016/j.anai.2014.03.008
30. Liu LY, Coe CL, Swenson CA, Kelly EA, Kita H, Busse WW. School Examinations Enhance Airway Inflammation to Antigen Challenge. Am J Respir Crit Care Med. 2002;165(8):1062-1067. doi:10.1164/ajrccm.165.8.2109065
31. Wright RJ, Berin MC. Unlocking the stress-allergy puzzle: need for a more comprehensive stress model. Ann Allergy Asthma Immunol. 2014;113(1):1-2. doi:10.1016/j.anai.2014.05.007
32. Weltman JK, Karim AS. IL-5: biology and potential therapeutic applications. Expert Opin Investig Drugs. 2000;9(3):491-496. doi:10.1517/13543784.9.3.491
Published
2023-11-01
How to Cite
AMTHA, Rahmi; TRI WULANDARI, Endah Ayu.
An Occurence of Oral Allergic Reactions in Patients with Illnes Anxiety Disorder.
Journal of Indonesian Oral Medicine Society, [S.l.], v. 1, n. 1, p. 1-7, nov. 2023.
ISSN 3026-6688.
Available at: <http://jurnal.pdgi.or.id/index.php/jioms/article/view/1096>. Date accessed: 22 dec. 2024.
Section
Case Reports
