İlaç Hipersensitivitesi ile Başvuran Hastalarda Anksiyete Düzeylerinin Değerlendirilmesi ve Öykünün Doğruluğu

Abstract

Drug hypersensitivity reactions (DHR) are important source of morbidity and mortality, therefore they constitute an important health problem. Some particular characteristics in the clinical history may help to predict the outcomes of diagnostic tests. High levels of anxiety has been reported in patients with a history of DHR, however its relationship with the objective test results has never been studied. In this study, we aimed to investigate the anxiety levels of patients with DHR, and the characteristics associated with positive test results. A total of 126 patients admitted to our clinic between November 2012 and April 2013 with a history of DHR. The patients who did not meet the exclusion criteria and accepted participation into the study underwent clinical evaluation, together with the application of ‘Penn State Worry Questionnaire’ (PSWQ) and tests with suspected drugs. The patient group was compared with a group of healthy individuals with regard to PSWQ scores. Patients in whom DHR was confirmed or excluded were compared with regard to their clinical characteristics and the reactions found to be ‘true DHRs’ were compared with the ones which were not. 67 patients were included in the study. The mean+SD age of the patients was 43.5+12.9 years and 73.1% of them were females. A definitive diagnosis of DHR (either proved or excluded) was reached in 50 patients. Male gender (p=0.04), asthma/persistant rhinitis/nasal polyposis (p=0.03), number of reactions (p=0.02), number of reactions with the same drug class (p=0.02), presence of a non-steroidal anti-inflammatory drug (NSAID) reaction in the history (p=0.02) were associated with a positive test result. In the multivariant logistic regression analysis, male gender (p=0.05) and the number of reactions (p=0.03) were associated with positive test results. Mean PSWQ score of the patient group was higher than the control group (p=0.008). With respect to reactions, presence of a drug from NSAID group (p=0.003), time of onset of reaction <1 hour (hr) (p=0.001), presence of rhinoconjuctivitis symptoms (p=0.007), respiratory symptoms (p<0.001), cardiovascular symptoms (p<0.001), symptoms of panic attack (p=0.01), application to the emergency department by ambulance (p=0.01) and resolution time of the reaction <3 hrs (p<0.001) were associated with positive test results. In the multivariant logistic regression analysis, reaction with a drug from NSAID group (p=0.01) and resolution time of the reaction <3 hrs (p=0.001) were associated with positive test results. In the model where only the symptom categories were added, presence of panic reaction symptoms lost its significance. In conclusion, some particular characteristics of the patients and reactions may be associated with positive test results in patients with a history of DHR. These patients tend to have higher levels of anxiety than the healthy controls, but level of anxiety is not associated with the confirmation of drug hypersensitivity. Since panic reaction symptoms may be seen together with the objective symptoms of drug hypersensitivity, a complete clinical work-up is required before deciding whether the reaction is related to panic or a ‘true DHR’.