الفهرس 
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Abstract
Background: Increased prevalence of psychological instability has been observed in patients with allergic rhinitis (AR). The nervous and immune systems regulate each other reciprocally, thus giving rise to a new field of study known as psychoneuroimmunology. It is not possible to affirm that stress is intrinsically able to cause allergy, though in genetically susceptible individuals, such stress may favor the appearance of allergic disease on one hand, and complicate the control of existing allergy on the other. Aim: to investigate existence of stress and its level in allergic rhinitis patients to determine the necessity of psychological assessment and the need for treatment of co-morbid stress as a part of multidisciplinary management of allergic rhinitis. Patients and Methods: 45 AR patients were included as patient group and 45 healthy subjects as control group. Both groups were subjected to full history, clinical examination including endoscopic assessment, lab investigations; CBC, stool analysis, serum total IgE and psychological assessment (BDA, TMAS, Leonard W. poon questionnaire). Results: The sex distribution was as follow 22 (48.9%) of control were males, 23 (51.1%) were females. 20 (44.4%) of cases were males 25 (55.6%) were females. All controls were free for allergic symptoms and signs, while all the cases had showed allergic symptoms and signs with variable degree of intensity. As regards the laboratory evidence of allergy all cases showed eosinophilia in their CBC analyses (100%), while only 1 person from the control group showed eosinophilia (2.2%) with statistically significant difference. Total IgE control mean was 30 (20-70) while it was 100 in the case group (70-200). And this was statistically significant. Psychological assessment of the enrolled subjects Showed; the first assessment (BDI) had 34.73 (14.25%) control mean and 41.38 (14.38%) case mean with P value 0.033 statistically significant. The second assessment (TMAS) had 13.38 (7.76%) control mean and 24.73(8.51%) case mean with P value <0.001 also statistically significant. The third assessment (leonard positive) the control mean was 29(4.3%) and 27.02 (4.15%) case mean with P value 0.0029 also statistically significant, (leonard negative) control mean was 10.73 (1.71%) and 17.33(2.08%) case mean with P value <0.001 statistically significant and the (leonard neutral) control mean was 17.91(3.5%) and 18.84 (3.57%) case mean with P value 0.214 statistically insignificant difference. Conclusion: Psychological assessment of allergic rhinitis patients had proved the existence of psychological disorders (stress, anxiety or depression) which affect the disease outcome. So we can conclude that allergic rhinitis patients need treatment of the co-morbid stress as a part of their management.