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Peer-reviewedCC BY-NC 4.0Journal of Asthma and Allergy

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

  • Ragıp Fatih Kural1,2
  • Ceyda Tunakan Dalgıç1
  • Sinem İnan3
  • Melih Özışık3
  • Serpil Akten1
  • Kasım Okan1
  • Reyhan Gumusburun1
  • Emine Nihal Mete Gökmen1
  • Aytül Zerrin Sin1
  1. 1Division of Allergy and Clinical Immunology, Department of Internal Medicine, Ege University Faculty of Medicine, İzmir, Turkey
  2. 2Division of Allergy and Clinical Immunology, İzmir Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey
  3. 3Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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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.

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Cite

BibTeXRIS
BibTeX
@article{kural2026anxiety,
  title = {{Anxiety Before and After Drug Provocation Testing in Drug Hypersensitivity: Who Remains Anxious Despite a Reassuring Test?}},
  author = {Ragıp Fatih Kural and Ceyda Tunakan Dalgıç and Sinem İnan and Melih Özışık and Serpil Akten and Kasım Okan and Reyhan Gumusburun and Emine Nihal Mete Gökmen and Aytül Zerrin Sin},
  journal = {Journal of Asthma and Allergy},
  year = {2026},
  month = oct,
  doi = {10.2147/jaa.s635317},
  url = {https://doi.org/10.2147/jaa.s635317},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Anxiety Before and After Drug Provocation Testing in Drug Hypersensitivity: Who Remains Anxious Despite a Reassuring Test?
AU  - Ragıp Fatih Kural
AU  - Ceyda Tunakan Dalgıç
AU  - Sinem İnan
AU  - Melih Özışık
AU  - Serpil Akten
AU  - Kasım Okan
AU  - Reyhan Gumusburun
AU  - Emine Nihal Mete Gökmen
AU  - Aytül Zerrin Sin
PY  - 2026
DA  - 2026/10/27
JO  - Journal of Asthma and Allergy
DO  - 10.2147/jaa.s635317
UR  - https://doi.org/10.2147/jaa.s635317
AB  - 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.
SN  - 1178-6965
ER  -