Nocebo effect, anxiety and depression

Published online: January 12, 2018

A drug provocation test, consisting of a controlled administration under medical surveillance of a drug suspected of being responsible for an allergic reaction, is the “gold standard” for drug allergy diagnosis. Frequently, patients undergoing a drug provocation test may develop allergy-like symptoms after the administration of an inert placebo that may be administered as part of the test. This phenomenon is known as the “nocebo effect.”

The study by Losappio et al., recently published in The Journal of Allergy and Clinical Immunology: In Practice, analyzed the psychological state of patients undergoing a drug provocation test by using a validated, standardized, self-administrable, and easy questionnaire called “Hospital Anxiety and Depression Scale (HADS)”, The purpose of administering the HADS was  to assess whether anxiety and depression may have influenced symptomatic patients as compared with asymptomatic patients during a drug challenge test, and how psychiatric symptoms influence patients in the development of reactions.

The main result of the study was the finding of a strong association between the positivity of the HADS questionnaire (for both anxiety and depression) and a placebo-induced reaction (nocebo effect), confirming that the nocebo effect can have presumably psychogenic causes.

The authors suggest that clinicians should evaluate patients for anxiety and depression before performing a drug provocation test.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.