Anxiety and depression effects during drug provocation test
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Laura M. Losappio, MD, PhD, Alessandra Cappai, MD, Alessandra Arcolaci, Iuliana Badiu, MD, Patrizia Bonadonna, MD, Elisa Boni, MD, Claudia Bussolino, MD, Marco Caminati, MD, Pietro Galati, MD, Enrico Heffler, MD PhD, Rossella Intravaia, MD, Marina Mauro, MD, Ilaria Massaro, MD, Antonino Gaetano Romano, MD, Gabriele Rumi, MD, Anna Parolo, MD, Stefano Pizzimenti, MD, Elide Anna Pastorello, MD
RATIONALE: Drug provocation test (DPT) represents the gold standard for the diagnosis of drug allergy. A DPT should be performed in a single-blind placebo controlled manner. In anxiety and depressive disorders, patients need to be evaluated to understand the nature of the placebo reactions. The aim of this study was to evaluate the psychological profile of patients with reactions to placebo during a drug challenge test,

METHODS: We consecutively enrolled patients with suspect drug allergy undergoing a drug challenge test preceded from the administration of the placebo. All patients underwent Hospital Anxiety and Depression Scale (HADS), a question to identify anxiety and depression, before the challenge test.

RESULTS: A total of 196 patients were enrolled into this study: sixteen (8.2%) resulted positive to HADS and 54 had at least one placebo reaction during drug provocation. There were statically significant correlations between HADS’ positivity and the finding of placebo-reaction (Fisher' exact test: p < 0.0001), and between the latter and a history of severe reactions to drug (Fisher' exact test: p < 0,0001).

CONCLUSIONS: There is a significant an strong correlation between the loss of psychic equilibrium and the development of placebo reaction during a drug provocation challenge. We suggest to use HADS or other validated questionnaire, in clinical practice before a drug challenge test in order to evaluate the possible psychiatric components.