Anxiety and depression effects during drug provocation test

Background Drug 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 placeboreactions. Objective The aim of this study was to evaluate the psychological profile of patients with reactions to placeboduring a DPT. Methods We consecutively enrolled patients with suspected drug allergyundergoing a DPT preceded by the administration of the placebo. All patients underwent the Hospital Anxietyand Depression Scale(HADS), a questionnaire aimed to identify anxiety and depression, before the challenge test. Results A 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 placeboreaction during drug provocation. There were statically significant correlations between the positivity of the HADS and the finding of a placeboreaction ( Fisher's exact test: P P Conclusions There is a significant and strong correlation between the loss of psychic equilibrium and the development of a placeboreaction 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.