Association of stress management skills and stressful life events with allergy risk: a case-control study in southern China

BACKGROUND: Psychosocial stress and stressful life events are known to aggravate allergic diseases. Less is known about the impact of stress management skills on allergies. Here we sought to determine whether stress management skills are associated with the allergies and to assess the combined effects of stress management skills and stressful events on allergy risk. METHODS: A survey on risk factors for self-reported allergic diseases was carried out among 28,144 southern Chinese people; 14 stressful life events and 8 stress management skills were retrospectively recorded in a case-control setting with multivariate logistic regression analysis. Multiplicative and additive interactions between stressful events and stress management skills were evaluated. RESULTS: Stressful events significantly increased allergy risk. The odds ratio (OR) for allergies was 1.65 (95% confidence interval CI, 1.41–1.93) for those reporting one or two stressful events and 3.10 (95% CI, 2.55–3.79) for those reporting more than three stressful events compared to participants without stressful events. Stress management skills were adversely associated with allergic risk for people experiencing stressful events (OR, 0.71; 95% CI, 0.53–0.97) when adjusted demographically, particularly “concentrate on pleasant thoughts at bedtime” (OR, 0.67; 95% CI, 0.51–0.89), “pace myself to prevent tiredness” (OR, 0.67; 95% CI, 0.54–0.83), “get enough sleep” (OR, 0.48; 95% CI, 0.32–0.72) and “take some time for relaxation each day” (OR, 0.55; 95% CI, 0.37–0.80). But in people without stressful events, no association was observed. There was a significant linear trend for allergy risk from good stress management skills with no stressful events to poor stress management skills with stressful events (P < 0.001), with significant interaction in additive models (P = 0.006). CONCLUSIONS: There are independent and antagonistic combined associations of stressful life events and stress management skills with allergy risk. The data supports the use of stress management skills in managing allergic disease among people with stressful life events. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-11333-3.