Prevalence of alexithymia in allergy and hypersensitivity: A systematic review and meta-analysis

Abstract

Alexithymia is a construct characterized by difficulty in identifying and expressing emotions and has been studied in various medical and psychological conditions. Allergic and hypersensitivity disorders are increasingly recognized for their chronic relapsing-remitting course and have been associated with alexithymia, yet the prevalence and extent of this association remain unclear. This systematic review and meta-analysis aimed to synthesize existing literature to determine the prevalence of alexithymia among individuals with allergies and hypersensitivity. A comprehensive search of major electronic databases (Cochrane, PubMed, ScienceDirect, and SCOPUS) was conducted on date February 2, 2023 of published studies till January 2023. Studies reporting on the prevalence of alexithymia in individuals diagnosed with allergic rhinitis, asthma, food allergies, and other hypersensitivity disorders were included. Quality assessment was performed using standardized tools, and meta-analysis was conducted to estimate pooled prevalence rates with 95% confidence intervals (CI). A total of 19 studies with a total of 2459 observations were included, with allergy or hypersensitivity disorders and alexithymia. The pooled prevalence of alexithymia among individuals with allergies was found to be 35.26% (95% CI: 27.86%–43.45%) with significant heterogeneity. Subgroup analyses showed a higher prevalence of alexithymia in dermatological conditions as compared to respiratory and gastrointestinal allergic conditions. Prevalence was highest for atopic dermatitis at 62.38% (55.50; 68.78) followed by other allergic conditions. There exists a considerable prevalence of alexithymia among individuals with allergy and hypersensitivity disorders. The findings are relevant while considering alexithymia in the clinical management of these conditions, potentially informing personalized treatment approaches and psychosocial interventions. Further research is warranted to elucidate the underlying mechanisms and bidirectional relationships between alexithymia and allergic/hypersensitivity disorders, emphasizing the need for interdisciplinary collaboration in clinical practice and research efforts.

In recent years, the complex relationship between psychological factors and physical health has received more importance. Alexithymia, one among many facets of psychological well-being, has made an impact in understanding how individuals differ while expressing their health needs and how emotional expression is processed among different health conditions leaving a significant impact on one’s chronic health condition.[1] Alexithymia is characterized by difficulty in identifying and expressing one’s own emotions, often accompanied by challenges in recognizing the emotions of others. The prevalence of alexithymia varies significantly across different medical conditions. Research indicates rates of 28% among psoriasis patients,[2] 37% in cancer patients,[3] and a substantial range of 15% to 52% among those with fibromyalgia.[4] In diabetes mellitus, the prevalence is notably higher at 43% among chronic non-communicable disorders.[5] Comparatively, the general population shows a much lower prevalence of alexithymia, estimated to be between 6% and 8%.[6] However, it would be curious to see how would it coexist with allergies and hypersensitivity. Disorders associated with allergies and hypersensitivity often run a chronic course, and an individual’s emotional expression does play a role in its relapse and remission. Allergies represent a significant public health burden, especially after the COVID-19 pandemic, affecting individuals across diverse demographics and impairing their quality of life.[7] The conventional understanding of these conditions has primarily focused on immunological responses triggered by exposure to allergens. However, emerging evidence suggests that the interplay between psychological factors, particularly alexithymia, and allergic conditions may be more fascinating than previously recognized. This comprehensive review would help to understand and estimate the prevalence of alexithymia in individuals with allergies or hypersensitivity reactions and explore the potential links between emotional processing difficulties and the manifestation or exacerbation of allergic symptoms.

It is essential to recognize the implications of uncovering such associations beyond the immediate clinical considerations. The findings of the review may help us to formulate management plans for chronic relapsing-remitting allergic conditions in individuals with alexithymia. Therefore, by bridging the prevalence gap of alexithymia in allergy research, this review seeks to contribute to the interconnectedness of mind and body.

MATERIALS AND METHODS

Information sources

A systematic literature search was conducted on February 2, 2023 by two independent authors (RS and AA) on the following databases: Cochrane, PubMed, ScienceDirect, and SCOPUS. In addition, the reference lists of the pertinent literature were screened for the relevant studies. The review was registered with the PROSPERO database under CRD42024517187.

Type of outcome measures

The primary aim of this review is to determine how prevalent alexithymia is among individuals who have allergies or hypersensitivity conditions. The secondary outcomes focus on examining the prevalence of alexithymia within specific types of allergies such as respiratory allergies, skin allergies, and food allergies.

Inclusion criteria

Studies where the prevalence of alexithymia was mentioned on any of the factors such as difficulty identifying emotions or difficulty describing emotions or externally oriented thinking or mild, moderate or severe category of alexithymia, or probable alexithymia or score of more than 51 on measure such as Toronto Alexithymia Scale (TAS) were included for the review

Exclusion criteria

We excluded studies that did not have relevant information on the prevalence of alexithymia among allergic conditions. We excluded the following article types: abstracts or conference reports or gray literature, case-only studies (case reports, case series), commentary, ecological studies, editorials, letters to the editor or correspondence (without data), meta-analyses, news articles, opinion articles, pooled analyses, reviews (narrative, scoping, systematic), and secular trend. All studies with information on the prevalence of alexithymia in non-allergic conditions were excluded. Also, studies not reporting quantitative data on the prevalence of alexithymia were excluded.

Selection process

RS and AA carried out the preliminary search. Authors AG and RS read the abstracts and extracted the relevant articles for full text in Microsoft Excel. AG removed any duplicate citations. AA resolved all discrepancies by color coding.

Data collection process

AG and RS identified studies mentioning the prevalence of alexithymia, reports on psychological distress, mental health problems, psychiatric morbidity, disability-adjusted life year (DALY), years of life lost (YLL), illness perceptions, quality of life, etc. AG extracted the data into a tabular form on Microsoft Word, and another full-text screening of all the articles was performed. Each article was extracted for raw data by AG and put into another table for further analysis.

Data items: The following data were collected

General information

Studies were researched in detail, including author, year of publication, title, journal (title, volume, and pages), source of publication, country of research, and the language of publication while removing all duplicate publications.

Prevalence of alexithymia and associated comorbidities

Details related to associated mental health issues comorbid with allergies such as stress, depression, and anxiety were recorded.

Critical appraisal of each study was performed using the JBI checklist for quality assessment.

It consists of 14 questions for cross-sectional and cohort studies and 12 questions for case-control studies.

Statistical analysis

The current meta-analysis provides prevalence estimates of alexithymia in allergy/hypersensitivity. These estimates were derived from selected research articles, and a pooled estimate of alexithymia was calculated. Generalized linear mixed models (GLMMs) logit transformation methods were employed to calculate effect sizes for each study, given their suitability for such calculations in this context.[8] Heterogeneity between studies was assessed using the I squared (I2) statistic and Cochran’s Q test. Due to considerable methodological heterogeneity, we applied a random effects model for analysis. Confidence intervals (CIs) for effect sizes of individual studies were computed using the Clopper-Pearson method. All effect sizes and pooled estimates are presented as proportions with 95% CIs. Publication bias was evaluated through visual inspection of funnel plots and Begg and Mazumdar, rank correlation test.[9,10] Data extraction was conducted using Microsoft Excel 2021 software, and statistical analyses were performed using the Meta and Metafor packages of R software.[11] Subgroup analyses were undertaken to explore sources of heterogeneity. Subgroup analyses were conducted based on country, type of allergic/hypersensitivity disorder, and human body organ system involved.

RESULTS

Study selection

A total of 72 studies were selected from the three databases. After excluding 15 duplicate studies through full-text screening, 47 studies were finally read in detail for eligibility. Also, three articles were excluded as they had mentioned alexithymia without allergy and had not reported any quantitative data on prevalence. Finally, 19 studies were included for quantitative synthesis [Supplementary Figure 1 ^{(1.2MB, tif)} ]. Studies with no relevant data[12,13,14,15,16,17,18,19,20,21] were excluded from the analysis.

Results of syntheses

After conducting a meta-analysis of 19 studies with a total of 2459 observations, the pooled prevalence of alexithymia among individuals with allergy was found to be 35.26% (95% CI: 27.86%–43.45%). Significant heterogeneity was observed among the studies, with an I² statistic of 91.2% (95% CI: 87.7%–93.7%) and a tau² value of 0.51, indicating substantial variability in the reported prevalence rates observed between study results. This suggests that factors beyond random chance contribute to the differences as shown in Figure 1.

Figure 1.

Forest plot showing the pooled prevalence of alexithymia in allergy

Results of individual studies

Table 1 summarizes the characteristics of the individual studies.

Table 1.

Characteristics of included studies

Author and study year	Country	Study design	Allergic condition	Sample size and demographic characteristics	Alexithymia assessments	Comorbid psychiatric conditions and mood states	Outcome
Baiardini et al., 2011[22]	Italy	Cross-sectional	Asthma and comorbid rhinitis	115 patients	TAS-20	Alexithymics had a significantly lower quality of life. They reported less energy, higher levels of tension, depression	Nearly 19% had alexithymia (TAS-20≥61). No gender difference was detected. Alexithymics had significantly lower asthma control test scores when compared with non-alexithymic
Barbosa et al., 2011[23]	Portugal	Cross-sectional	Chronic idiopathic urticaria	55 patients with chronic idiopathic urticaria and 31 healthy control group (mean age 45.25 years, SD=16.12)	TAS-20 Hospital anxiety and depression scale NEO five-factor inventory Short form 36 health survey	Alexithymia traits were significantly positively correlated with insecure attachment styles, with psychopathological symptoms, and with the defense mechanism turned against the self.	56.9% of CU patients were associated with alexithymia.
Barbosa et al., 2011[24]	Portugal	Cross-sectional	Systemic Lupus erythematosus and asthma	53 SLE patients, and 41 asthma patients. (mean±SD age, 39.50±10.98 years)	TAS-20 Brief symptom inventory, Hospital anxiety and depression scale NEO-FFI Short form – 36 health survey	Openness and depression were the two predictors of alexithymia in SLE patients.	50.9% (n=27) of SLE patients had alexithymia (TAS-20≥61).
Braido et al., 2011[25]	Italy	Cross-sectional	Chronic obstructive pulmonary disease	164 patients (mean±SD age, 73.4±8.59 years).	TAS-20 Psychological General Well-Being Index Health status (SF-36), Illness perception questionnaire	32.9% of the population had a positive well-being, 27.1% distress absence, 37.1% moderate distress, and 2.9% severe distress.	32.9% patients had alexithymia.
Cherrez-Ojeda et al., 2023[26]	Ecuador	Cross-sectional	Chronic urticaria	We included 423 patients (54.4% females) with a mean age of 42.4 years	TAS-20	NA	A total of 42.1% of the participants were found to have alexithymia, 21.5% had possible alexithymia, and 36.4% did not have alexithymia.
Chiricozzi et al., 2020[27]	Italy	Multicenter cross-sectional	Atopic Dermatitis (AD)	202 atopic dermatitis patients and 240 healthy subjects.	TAS-20	NA	27.7% of AD patients had alexithymia (TAS-20 score ≥61), 35.6% were borderline alexithymics as compared to 7.5% subjects alexithymics, 21.7% borderline alexithymics in the control group. Alexithymia was more common among severe AD patients (43.6%) compared to mild AD patients (15.6%) and correlated with itch intensity and sleep disturbances.
Chugg et al., 2009[28]	Adelaide	Cross-sectional	Asthma	A total of 11 male (44%) and 14 female (56%) patients with moderate to severe persistent asthma (mean age 44 years±11) participated.	-TAS-20	NA	12% of participants reported high alexithymia scores, 32% reported borderline alexithymia scores, and 56% reported low alexithymia scores. A higher alexithymia score was associated with a worse asthma control score.
Dafauce et al., 2021[29]	Spain	Cross-sectional	Asthma	63 patients with severe asthma. The mean age was 60±13.6 years.	TAS-20 Hospital Anxiety and Depression Scale (HADS),	The rate of anxiety and/or depression (HADS≥11) was 68.3%.	42.9% of asthmatic patients had alexithymia.
Innamorati et al., 2015[30]	Italy	Cross-sectional	Bronchial Asthma	153 patients	TAS-20 State-trait anxiety inventory state subscale The beck depression inventory The beck cognitive insight scale	Patients with severe airway obstruction and high alexithymia reported higher self-reflectiveness and more depressive symptoms.	51% of patients had severe alexithymia.
Liotta et al., 2023[31]	Italy	Cross-sectional	Allergic Asthma	18 patients	TAS-20 Asthma control test Asthma quality of life questionnaire	NA	33.3% (n=6) patients had alexithymia (TAS 20≥61). Alexithymia does not interfere in the treatment of severe allergic asthma with omalizumab (an anti-IgE monoclonal antibody).
Polloni et al., 2018[32]	Italy	Cross-sectional	Food allergy	69 patients (female=40.5%; Mean age=15.59) with IgE food allergy.	TAS-20	NA	17.4% (n=12) participants resulted in alexithymic (TAS >60) and 39.1% (n=37) were borderline-alexithymic. (51< TAS <60)
Polloni et al., 2022[33]	Italy	Cross-sectional	Food allergy	65 mother-child pairs	TAS-20 State trait anxiety inventory	Child alexithymia showed a positive association with previous anaphylaxis and mothers’ trait anxiety Maternal anxiety and previous anaphylaxis showed an association with alexithymia in young patients with food allergies.	21.5% of children had alexithymia while 33.8% of children were borderline alexithymics. Mothers’ frequencies were lower and in line with prevalence in the general population.
Feguine and Jones, 1987[34]	USA	Cross-sectional	Chronic bronchitis/emphysema	96 patients with chronic bronchitis/emphysema	22-item MMPI alexithymia scale	NA	The non-alexithymic sample was composed of 54 subjects while 42 subjects comprised the alexithymic sample. No gender differences were seen.
Serrano et al., 2006[35]	Barcelona	Clinical trial	Near-fatal asthma	179 NFA patients and 40 non-NFA patients, as a control group.	TAS-20	NA	A higher proportion of alexithymia was found in the NFA group than in the non-NFA group. (36% vs 13%).
Vazquez et al., 2010[36]	Spain	Cross-sectional	Near-fatal asthma	44 NFA patients (63.6% female; mean age=53.80±20.44, range 18–83) and 40 control group patients (63.6% female; mean age=54.25±17.48 years, range 21–86)	TAS-20 Cognitive depression inventory Trait-anxiety scale The practical knowledge of self-management questionnaire.	In comparison with non-NFA patients, NFA patients showed higher levels of trait anxiety. NFA and non-NFA patients did not differ in self-management variables.	9% (n=4) patients in NFA group had alexithymia (TAS-20≥61). No alexithymics were found in the control group.
Vazquez et al., 2010[37]	Spain	Cross-sectional	Asthma	76 patients with asthma. Mean age (42.67±15.33)	TAS-20 (20-item Toronto Alexithymia Scale)	The cognitive depression index The trait subscale of the State-Trait Anxiety Inventory -The Short-Form 36 Health Survey (SF-36) -	31 subjects had alexithymia at least in the domain of difficulty in identifying feelings while most (30.95%) of them had at least one emergency room visit during the follow-up.
Venegas, 2020[38]	Ecuador, Argentina, USA	Cross-sectional	Asthma	265 patients, mean age 54.7 years	TAS-20 (20-item Toronto Alexithymia Scale)	NA	Alexithymia is more common in populations with lower educational levels. In total, 30.2% of individuals presented alexithymia and 23.8% possible alexithymia Individuals with alexithymia present with more severe asthma, more frequently than healthy individuals.
Moes-Wójtowicz et al., 2012[39]	Poland	Cross-sectional	Asthma	54 patients, (mean age 54.37±14.52 yrs)	TAS-26 Asthma control test	NA	21% of patients were found to have alexithymia. No connection between asthma control and alexithymia was found.
Ghorbani et al., 2017[40]	Iran	Cross-sectional		300 patients with asthma and 100 normal controls	TAS-20 (Persian version) The demographic questionnaire The cognitive emotion regulation questionnaire (CERQ) The Powell & Enright Physical Symptoms Inventory (PSI)	NA	192 patients had alexithymia on any subscales of TAS (Persian version) were predictors and physical symptoms were outcome variables. Alexithymia subscales had indirect effects on physical symptoms via catastrophizing.

NA – Not available, TAS-20 – 20-item Toronto Alexithymia Scale

Subgroup analysis

Asthma exhibited a pooled prevalence of 31.08% (95% CI: 21.86%–42.08%), with significant heterogeneity (I² = 92.8%). Chronic idiopathic urticaria showed a pooled prevalence of 43.07% (95% CI: 38.69%–47.56%), with moderate heterogeneity (I² = 33.2%) as shown in Figure 2. Other disorders such as SLE, COPD, atopic dermatitis, chronic bronchitis/emphysema, and food allergy also demonstrated varying prevalence rates, indicating the need for further investigation into disorder-specific factors influencing alexithymia prevalence. A test for subgroup differences revealed significant variability between the disorder groups (Q = 66.03, df = 6, P < 0.0001), highlighting the importance of considering specific allergic disorders while assessing the prevalence of alexithymia. The country-wise distribution suggests the highest prevalence of 64% [58.41; 69.23] in Iran and the lowest prevalence of 12% (3.92; 31.30) in Australia as shown in Figure 3. Prevalence was highest for atopic dermatitis at 62.38% (55.50; 68.78) followed by other allergic conditions as shown in Figures 3 and 4.

Figure 2.

Forest plot showing disorder-wise distribution of pooled prevalence of alexithymia in allergy

Figure 3.

Forest plot showing region-wise distribution of pooled prevalence of alexithymia in allergy

Figure 4.

Forest plot showing system-wise distribution of pooled prevalence of alexithymia in allergy

JBI quality assessment tool was used for critical appraisal of the included studies as shown in Figure in Supplementary File. We found low risk of bias across 19 studies. With regard to publication bias, the rank correlation test of funnel plot asymmetry showed z = −1.36, P value = 0.172, bias estimate: 39 (SE = 28.58) as per Begg and Mazumdar rank correlation test. Eggers’s test by linear regression test showed t = −2.14, df = 17, P value = 0.0467, and bias estimate: −3.53 (SE = 1.65). On visual inspection of the funnel plot and rank correlation test, there is no publication bias as shown in Figure 5.

Supplementary File.

JBI critical appraisal checklist for RCT studies
Study	Item 1	Item 2	Item 3	Item 4	Item 5	Item 6	Item 7	Item 8
Baiardini et al., 2011	Yes	Unclear	Yes	No	No	Yes	Unclear	Yes
Barbosa et al., 2011	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Barbosa F et al., 2011	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Braido F et al., 2011	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Cherrez-Ojeda I et al., 2023	Unclear	Unclear	Yes	Yes	No	Yes	Unclear	Yes
Chiricozzi A et al, 2020	Yes	Unclear	Yes	Yes	Unclear	Yes	Yes	Yes
Chugg K et al., 2009	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Dafauce L et al., 2021	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Feiguine and Jones, 1987	Yes	Yes	Yes	Unclear	Unclear	Yes	Unclear	Yes
Ghorbani F et al, 2017	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Innamorati M et al., 2015	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Liotta M et al, 2023	Yes	Yes	Yes	Unclear	Unclear	Unclear	Unclear	Unclear
Moes-Wójtowicz, A et al., 2012	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Polloni et al., 2022	Yes	Yes	Yes	Yes	Unclear	Yes	Unclear	Yes
Polloni L et al., 2018	Yes	Yes	Yes	Yes	Unclear	Yes	Yes	Yes
Serrano J et al, 2006	Yes	Yes	Yes	Yes	Unclear	Yes	Yes	Yes
Vázquez et al., 2010	Yes	Yes	Yes	Yes	Yes	Yes	Unclear	Yes
Vázquez et al., 2010	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
Venegas et al., 2020	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes

Figure 5.

Funnel plot showing the absence of publication bias

DISCUSSION

The findings of the review inform us of the significant prevalence of alexithymia among individuals with allergic conditions as compared to the general population, with a pooled prevalence estimate of 35.26%. This emphasizes a significant proportion of individuals with allergies display psychological and emotional processing challenges. The psychosomatic nature of chronic medical conditions such as allergies would require addressing psychological aspects alongside physical symptoms in clinical care to improve the quality of life. The prevalence of alexithymia in the general population is lower and ranges from 8% to 13%.[1] Compared to psychiatric patients who exhibit higher rates of alexithymia ranging from 25% to 65%, depending on the psychiatric disorder, we recognize a slightly lower prevalence in allergic conditions but undoubtedly higher than the general population. Additionally, alexithymia has been associated with various chronic medical conditions, indicating a complex relationship between emotional processing difficulties and physical health.[41]

Interestingly, distinct patterns emerged when comparing the prevalence of alexithymia across different types of allergies. Respiratory allergies, such as asthma and COPD, exhibited prevalence rates ranging from 31.08% to 39.02%, with notable heterogeneity observed within the asthma subgroup. Conversely, skin allergies, including chronic idiopathic urticaria and atopic dermatitis, demonstrated higher prevalence rates ranging from 43.07% to 62.38%, with comparatively lower heterogeneity. Similarly, studies on food allergies reported prevalence rates ranging from 19.40% to 43.75%, suggesting variability in alexithymia prevalence across different allergic conditions. The skin’s role as the largest and most visible organ may contribute to higher alexithymia levels in dermatological allergic conditions.[26] Visible symptoms like rashes and inflammation often lead to social anxiety, impacting self-image and emotional processing which is dysfunctional in psychosomatic patients. The skin’s connection to the nervous and immune systems also creates a stress-symptom cycle, making emotional regulation challenging. In contrast, gastrointestinal and respiratory allergies, which are less visible, may involve relatively fewer social and psychological pressures, and avoidance of certain situations, allowing for better emotional management. The skin’s unique social visibility likely intensifies emotional strain, explaining why dermatological conditions could rank higher in alexithymia. Furthermore, the episodic and often manageable nature of gastrointestinal symptoms, such as avoiding trigger foods, might enable individuals to maintain a better sense of emotional control. Additionally, the gut-brain axis, a complex bidirectional communication system between the gastrointestinal tract and the brain, may allow individuals with gastrointestinal conditions to be more attuned to their emotional states, contributing to lower levels of alexithymia in this group.

The relationship between alexithymia and allergy is bidirectional. Emotional processing difficulties can profoundly impact physical health, affecting physiological processes, immune functioning, and overall well-being. When individuals struggle to identify, understand, and express their emotions, as in alexithymia, it can heighten stress levels and hinder adaptive coping strategies, potentially exacerbating physical health problems. Conversely, chronic allergic conditions and physical health issues can contribute to emotional distress in relapsing-remitting patterns,[42,43] further complicating the relationship. These eventually result in unhealthy behaviors, such as poor dietary habits and substance abuse, which can adversely affect physical health. From a neurobiological standpoint, various physiological mechanisms involved in chronic stress responses such as dysregulation of the hypothalamic-pituitary-adrenal axis and release of stress hormones such as cortisol, leading to elevated blood pressure, impaired immune function, could contribute to increased inflammation.[44] The resonating functional structures in the brain to this inflammation such as the amygdala and prefrontal cortex may further influence pain perception, allergic sensitivity, harm avoidance, overgeneralization, fear conditioning, impaired sleep biology, and reward processing. Conversely, chronic allergic skin conditions involve histamine, bradykinin, and substance P, and other chemokines can alter neurotransmitter levels and neural circuitry involved in emotion regulation, exacerbating emotional processing difficulties. Therefore, altered signal processing between the brain and body enables emotions to modulate immune function and physiological processes that determine overall well-being and physical health. Our findings highlight the increased prevalence of alexithymia across diverse allergic contexts, necessitating further research to elucidate underlying mechanisms and inform targeted therapeutic approaches.

Limitations

The heterogeneity observed across studies in terms of sample characteristics, assessment tools, and study methodologies impact the generalizability of our findings. The cross-sectional nature of most included studies limits our ability to establish causal relationships between alexithymia and allergic conditions or to determine the directionality of the observed associations. We have not taken care of other psychosocial variables such as socioeconomic status, comorbid psychiatric disorders, and environmental factors that could influence the relationship between both. Therefore, given the complexity of alexithymia, its dimensions, and subtypes, a more comprehensive understanding of its impact on individuals with allergic conditions is required in future studies.

CONCLUSION

Prevalence of alexithymia in allergic conditions highlights the complex relationship between emotional processing difficulties and physical health. Through our analysis, we have observed that individuals with allergies, particularly respiratory and skin allergies, exhibit varying rates of alexithymia, reflecting the unexplored nature of psychosomatic experience within different allergic manifestations. Furthermore, emotional processing difficulties observed in alexithymic individuals lack coherence between psychological and biological factors. Psychological factors, such as chronic stress and maladaptive coping strategies while biological mechanisms, including neurobiological responses and bidirectional communication between the brain and body, can contribute to the exacerbation of physical health issues. These findings entertain the alexithymia as an independent construct required to be addressed for the overall well-being of an individual with an allergic condition. Moving forward, interventions aimed at addressing emotional processing difficulties alongside physical health concerns are imperative for promoting holistic health and improving outcomes for individuals with allergic conditions and beyond. Further research is needed to elucidate the underlying mechanisms and develop tailored approaches that address the multifaceted nature of this relationship comprehensively.

Authors’ contributions

Conceptualization of the review: AG, AA, RS, and VY. Data collection, screening, data extraction, and draft writing: AG and RS. Material preparation, data analysis, and writing of the report: AA and VY. All authors contributed to the writing and proofreading of the review.

Data availability

The data will be available upon reasonable request.

Conflicts of interest

There are no conflicts of interest.

Supplementary Figure 1

PRISMA flow diagram

Funding Statement

Nil.