Assessment of psychological aspects during systemic provocation tests in patients with pseudoallergic drug reactions

Background  Basic mechanisms of pseudoallergic drug reactions as well as a possible role of the psyche are currently unknown. Objective  Examination of psychological status and reactions during diagnostic provocation tests in patients with previous pseudoallergic reactions to drugs. Subjects and methods  Ten inpatients, admitted for provocation tests, were studied in a double-blind, placebo-controlled setting, with inventories of anxiety and depression being measured at baseline and psychological reactions and symptoms being recorded daily by patients and the attending physician. Results  Patients reported more than twice as many symptoms as the physician, independent of the type of exposure. While the basic psychological profile of the patients was normal, anxiety trait and state values were high during testing, with a significant increase depending on whether the patients thought they had received a drug or a placebo. Similarly, frequency of symptoms was dependent on the patients’ perception of the type of exposure. Conclusion  These findings demonstrate a high level of anxiety during systemic provocation tests in patients with previous pseudoallergic drug reactions, raising serious questions as to the diagnostic validity of the routine application of this testing.