Allergy Asthma Immunol Res.  2020 May;12(3):496-506. 10.4168/aair.2020.12.3.496.

A Prospective Observation of Psychological Distress in Patients With Anaphylaxis

Affiliations
  • 1Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea. ye9007@ajou.ac.kr
  • 2Department of Psychiatry and Behavioral Sciences, Ajou University School of Medicine, Suwon, Korea.
  • 3Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
  • 4Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.
  • 5Division of Allergy, Asthma, and Clinical Immunology, Chonnam National University Medical School, Gwangju, Korea.
  • 6Division of Allergy and Clinical Immunology, Seoul National University College of Medicine, Seoul, Korea.
  • 7Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
  • 8Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
  • 9Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 10Division of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 11Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
  • 12Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea.
  • 13Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
  • 14Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
  • 15Division of Allergy and Immunology, Yonsei University College of Medicine, Seoul, Korea.
  • 16Division of Pulmonary, Allergy and Critical Care Medicine, CHA University, Seongnam, Korea.
  • 17Clinical Trial Center, Ajou University Hospital, Suwon, Korea.

Abstract

PURPOSE
Anaphylaxis is an immediate allergic reaction characterized by potentially life-threatening, severe, systemic manifestations. While studies have evaluated links between serious illness and posttraumatic stress disorder (PTSD), few have investigated PTSD after anaphylaxis in adults. We sought to investigate the psychosocial burden of recent anaphylaxis in Korean adults.
METHODS
A total of 203 (mean age of 44 years, 120 females) patients with anaphylaxis were recruited from 15 university hospitals in Korea. Questionnaires, including the Impact of Event Scale-Revised-Korean version (IES-R-K), the Korean version of the Beck Anxiety Inventory (K-BAI), and the Korean version of the Beck Depression Inventory (K-BDI), were administered. Demographic characteristics, causes and clinical features of anaphylaxis, and serum inflammatory markers, including tryptase, platelet-activating factor, interleukin-6, tumor necrosis factor-α, and C-reactive protein, were evaluated.
RESULTS
PTSD (IES-R-K ≥ 25) was noted in 84 (41.4%) patients with anaphylaxis. Of them, 56.0% had severe PTSD (IES-R-K ≥ 40). Additionally, 23.2% and 28.1% of the patients had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17), respectively. IES-R-K was significantly correlated with both K-BAI (r = 0.609, P < 0.0001) and K-BDI (r = 0.550, P < 0.0001). Among the inflammatory mediators, tryptase levels were lower in patients exhibiting PTSD; meanwhile, platelet-activating factor levels were lower in patients exhibiting anxiety and depression while recovering from anaphylaxis. In multivariate analysis, K-BAI and K-BDI were identified as major predictive variables of PTSD in patients with anaphylaxis.
CONCLUSIONS
In patients with anaphylaxis, we found a remarkably high prevalence of PTSD and associated psychological distresses, including anxiety and depression. Physicians ought to be aware of the potential for psychological distress in anaphylactic patients and to consider psychological evaluation.

Keyword

Anaphylaxis; stress disorders, post-traumatic; psychological distress; anxiety; depression

MeSH Terms

Adult
Anaphylaxis*
Anxiety
C-Reactive Protein
Depression
Hospitals, University
Humans
Hypersensitivity
Interleukin-6
Korea
Multivariate Analysis
Necrosis
Prevalence
Prospective Studies*
Stress Disorders, Post-Traumatic
Tryptases
C-Reactive Protein
Interleukin-6
Tryptases
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