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

• Lee Y
• Chang HY
• Kim SH
• Yang MS
• Koh YI
• Kang HR
• Choi JH
• Kim CW
• Park HK
• Kim JH
• Nam YH
• Kim TB
• Hur GY
• Jung JW
• Park KH
• Kim MA
• Kim J
• Yoon J
• Ye YM

• KMID: 2471232
• DOI: http://doi.org/10.4168/aair.2020.12.3.496

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

Figure

• 

  Fig. 1 Measurements of IES-R-K, K-BAI, and K-BDI and the proportion of patients who scored over the cut-off point of each questionnaire.PTSD, posttraumatic stress disorder; IES-R-K, the Impact of Event Scale-Revised-Korean version; K-BAI, Korean version of the Beck Anxiety Inventory; K-BDI, Korean version of the Beck Depression Inventory.

• 

  Fig. 2 Correlations for IES-R-K with K-BAI (A) and K-BDI (B) in patients with anaphylaxis.IES-R-K, the Impact of Event Scale-Revised-Korean version; K-BAI, Korean version of the Beck Anxiety Inventory; K-BDI, Korean version of the Beck Depression Inventory.

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