Drug-Induced Reactions, Anaphylaxis Impair Mental Health, Quality of Life

Among drug hypersensitivity reactions, anaphylaxis and other respiratory manifestations carried the highest risk of permanently impairing HRQoL.

Drug hypersensitivity reactions (DHRs), especially anaphylaxis, markedly affect patients’ health-related quality of life (HRQoL) and mental health, according to a systematic review and meta-analysis published in The Journal of Allergy and Clinical Immunology: In Practice.

DHRs, which are not dose-dependent, not related to pharmacological effects of the drug, and are unpredictable, resemble allergy, and are responsible for almost a quarter of anaphylaxis cases in Europe, with mortality ranging from 3,700 to 4,300 per million per year. Investigators assessed the prevalence of drug hypersensitivity reactions that affect health-related quality of life and mental health, as well as associated risk factors.

The investigators conducted a systematic review and meta-analysis searching the SCOPUS, Medline, and American Psychological Association PsychArticles databases through December 2022 for observational studies, randomized clinical trials, conference abstracts, and reviews published in English that included evaluations of mental health and/or quality of life among patients with at least 1 episode of DHR.

The meta-analysis included 23 observational, nonrandomized studies reporting quantitative measures. The investigators noted significant between-study heterogeneity (I2>70%) possibly attenuated by the homogeneous direction of the effect size among the studies. Risk of bias ranged from high to very high for most included studies.

Despite the scarce and heterogeneous studies on this topic, the review shows that HRQoL and mental health are markedly impacted after adverse drug reactions.

In those experiencing DHRs, moderate-to-severe anxiety in patients with at least 1 episode of DHR was prevalent in up to 48% of patients (odds ratio [OR], 3.92; 95% CI, 1.91-8.05) vs healthy individuals, whereas the prevalence of mild anxiety was up to 16.4% in those with DHRs vs healthy individuals. Prevalence of depression in those with DHRs was as much as 51.4% (OR, 2.94; 95% CI, 1.42-6.10) vs healthy individuals and up to 18.3% compared with patients with comorbidities including allergic diseases (Hymenoptera venom allergy, asthma, rhinitis). Researchers also found that hysteria, somatization, alexithymia, and panic were more frequent in patients with ADRs, especially in those with multiple drug intolerance syndrome,

The investigators noted DHRs significantly affected HRQoL particularly in patients with drug-induced anaphylaxis (mean score, 5.88; 95% CI, 0.77-10.98) vs patients without anaphylaxis. This significant effect of anaphylaxis was also seen in relation to patients with a DHR with only skin involvement (mean score, 5.39; 95% CI, 0.84-9.95); however, there were no significant differences between patients experiencing anaphylaxis vs patients with only respiratory involvement.

Although anaphylaxis significantly affected patients’ feelings of insecurity and fear, it did not limit patients’ mood and daily activities. Mood and daily activities were more affected by osteoarticular comorbidity. History of multiple reactions did affect patients’ insecurity and fear. Sex, age, chronic disease (other than osteoarticular conditions), and elapsed time from the last reaction did not have a significant effect on HRQoL.

Overall, the meta-analysis suggested that HRQoL is permanently impaired by DHRs (even if experienced only during the acute episode) due to unpleasant memories and continuous vigilance to avoid future trigger exposure, the investigators noted.

Review and meta-analysis limitations include the observational nature of all included studies, recall bias in studies with self-reported events, and between-study heterogeneity (failure to account for preexisting mental disorders). Additionally, preexisting mental disorders were unaccounted-for in the included studies and may have led to overdiagnosis of adverse drug reactions.

“Despite the scarce and heterogeneous studies on this topic, the review shows that HRQoL and mental health are markedly impacted after adverse drug reactions,” the investigators concluded. They wrote “Psychological support may help to screen patients at risk or already with mental disorders, facilitate the identification of symptoms which are primarily somatic/psychogenic instead of real ADRs, and characterize the psychological profile of patients to find the best tailored approach for diagnosis and management of drug allergy.”

This article originally appeared on Pulmonology Advisor


Martini M, Di Taranto M, Höfer V, Worm M, Bilò MB. Health-related quality of life and mental health in drug hypersensitivity reactions and drug-induced anaphylaxis: a systematic review and meta-analysis. J Allergy Clin Immunol Pract. Published online March 21, 2023. doi:10.1016/j.jaip.2023.03.012