Dr. Sheikh and Colleagues Reply

To the Editor: We thank Dr. Kennedy for her thoughtful comments and suggestions for future investigations with panic disorder patients concerning the relationship of gender, allergies, and respiratory symptoms. Our secondary analyses of National Comorbidity Survey data did not extend to potential pulmonary disorders or to specialty medical use associated with panic-related respiratory disturbance. However, Dr. Kennedy’s suggestion of heightened panic response in allergy patients is consistent with Dr. Klein’s observations (1) that hypersensitive false-alarm mechanisms underlie the dyspneic response observed during panic attacks. We are aware of two studies that have examined panic response in patients with multiple chemical sensitivity and idiopathic environmental intolerance (2, 3). Binkley et al. (2) found that four of five self-identified “chemically sensitive” patients who complained of respiratory complaints met diagnostic criteria for panic disorder. Further, patients with multiple chemical sensitivity syndrome responded with panic symptoms when administered sodium lactate, a well-known panicogen, but not when they were administered saline solution. We encourage Dr. Kennedy to further investigate the potential for undetected panic disorder in allergy patients and the possibility for converging pathophysiologies between these two disorders.