Anxiety and Depression Effects during Drug Provocation Test

Publication date: Available online 12 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Laura Michelina Losappio, Alessandra Cappai, Alessandra Arcolaci, Iuliana Badiu, Patrizia Bonadonna, Elisa Boni, Claudia Bussolino, Marco Caminati, Pietro Galati, Enrico Heffler, Rossella Intravaia, Marina Mauro, Ilaria Massaro, Antonino Romano, Gabriele Rumi, Anna Parolo, Stefano Pizzimenti, Michele Nichelatti, Elide Anna Pastorello
BackgroundDrug provocation test (DPT) represents the gold standard for the diagnosis of drug allergy. A DPT can be performed in a single-blind placebo-controlled manner. In anxiety and depressive disorders, patients need to be evaluated to understand the nature of placebo reactions.ObjectiveThe aim of this study was to evaluate the psychological profile of patients with reactions to placebo during a DPT.MethodsWe consecutively enrolled patients with suspected drug allergy undergoing a DPT preceded by the administration of the placebo. All patients underwent the Hospital Anxiety and Depression Scale (HADS), a questionnaire aimed to identify anxiety and depression, before the challenge test.ResultsA total of 196 patients were enrolled into this study: 8 (4%) patients resulted positive to the DPT, 60 (30.6%) demonstrated anxiety or depression based on the HADS, and 54 had at least 1 placebo reaction during drug provocation. There were statically significant correlations between the positivity of the HADS and the finding of a placebo reaction (Fisher's exact test: P < .001), and between the latter and a history of severe reactions to drug (Fisher's exact test: P < .001).ConclusionsThere is a significant and strong correlation between the loss of psychic equilibrium and the development of a placebo reaction during a DPT. We suggest the use the HADS or other validated questionnaire in clinical practice before a DPT to evaluate the possible psychiatric components.