Work

Anxiety Before and After Drug Provocation Testing in Drug Hypersensitivity: Who Remains Anxious Despite a Reassuring Test?

Year: 2026

Type: article

Abstract: Purpose: Drug provocation testing (DPT) is the gold standard for diagnosing drug hypersensitivity reactions (DHRs). We assessed the change in anxiety from baseline to one week after DPT and identified which patients remain anxious despite a negative (reassuring) test, alongside correlates of the nocebo response. Patients and Methods: In this ambispective (retro-prospective) two-center study, 155 adults with suspected immediate-type DHR underwent single-blind, placebo-controlled DPT. Anxiety was measured with the Beck Anxiety Inventory (BAI) before and one week after testing. Factors associated with baseline anxiety, residual (post-test) anxiety and the nocebo response were examined in the full cohort. For residual anxiety, the post-test BAI score was the primary outcome, and a sensitivity analysis was restricted to DPT-negative patients. Results: DPT was negative in 147 patients (94.8%); among 57 tested with the culprit drug, 53 (93.0%) were de-labeled. BAI fell from 15.7±15.0 to 4.8±7.8 (p<0.001; r=0.75). The proportion with at least moderate anxiety (BAI ≥16) decreased from 41.9% to 5.2%. Residual anxiety (BAI ≥8) persisted in 36 patients (23.2%) and was associated with baseline anxiety. Baseline anxiety was associated mainly with a severe index reaction, psychiatric history and low income. Atopy showed an exploratory, baseline-adjusted association with residual anxiety (+3.2 points; p=0.004). A nocebo response occurred in 20.0% of patients. In exploratory multivariable analysis, recurrent prior reactions remained independently associated with this response (low income less consistently), whereas baseline anxiety did not. Conclusion: In this single-arm study, anxiety fell substantially after DPT and most patients tested with the culprit drug were de-labeled, but a negative result did not reassure everyone. Residual anxiety was associated with elevated baseline anxiety and, less robustly, with atopy; nocebo responses related mainly to recurrent prior reactions. Brief pre-test screening could thus direct targeted psychological support to those least reassured by testing alone.

Source: Journal of Asthma and Allergy

DOI: 10.2147/jaa.s635317