Pitfalls in Respiratory Allergy Management: Alexithymia and Its Impact on Patient-Reported Outcomes

Objectives. Alexithymia is a personality trait characterized by a limited ability to identify and express emotions and it represents a possible risk factor for disease development and management. The objective of the study is to evaluate alexithymia in patients with persistent asthma and comorbid rhinitis and its relation with patient-reported outcomes (PROs). Methods. Alexithymia, quality of life, illness perception, and stress were assessed, as well as rhinitis symptoms and asthma control in out-patients classified according to GINA and ARIA guidelines. Results. Out of 115 patients, 19% turned out to be alexithymic (TAS-20 >= 61). Concerning alexithymia level, no difference was detected between males and females (chi(2) = 0.317) and among GINA levels (chi(2) = 0.22). Alexithymics had significantly lower Asthma Control Test scores when compared with non-alexithymics (15.86 vs. 19; p = .02). Alexithymics had a worse quality of life (p < .001) and, concerning illness perception, they ascribed to respiratory allergy symptoms that are not strictly disease related and referred to asthma and rhinitis more serious negative consequences (p < .001) and emotional representations (p < .035). Moreover, they had lower illness coherence (p < .001) and lived their disease as a cyclical rather than a chronic disorder ( p < .035). As regards stress, alexithymics reported less energy ( p < .001), higher levels of tension ( p <.001), depression ( p <.001), confusion ( p >.001), and inertia ( p <.001). Conclusion. Alexithymia is present in a relevant percentage of subjects and, as it can modulate illness perception, quality of life, and stress, it should be considered in disease management.