Allergy and psychologic evaluations of patients with multiple drug intolerance syndrome

Abstract

The multiple drug intolerance syndrome is a clinical entity characterized by adverse drug reactions to at least three drugs, chemically, pharmacologically and immunogenically unrelated, manifested upon three different occasions, and with negative allergy testing. Symptoms referred by the patients are often subjective, of neurovegetative origin. The aim of the study is to characterize patients suffering from the multiple drug intolerance syndrome from a psychological point of view, and to compare them to healthy subjects. We studied 30 women suffering from the multiple drug intolerance syndrome. All subjects underwent the following psychodiagnostic tests: (1) the State Trait Anxiety Inventory-Form Y, (2) the Zung Self-rating Anxiety Scale, (3) the Zung Self-rating Depression Scale, (4) the Quality of life enjoyment and satisfaction questionnaire, (5) the Minnesota Multiphasic Inventory-2, (6) the Toronto Alexithymia Scale. The study group was compared to 30 healthy women. When compared with the control group, our patients showed: a higher anxiety, a higher grade of depression, this difference was statistically significant (p < 0.01); a high difference (p < 0.01) between the two groups as regards somatic symptoms; a higher grade of alexithymia (p < 0.01); and a worse quality of life, in all the analyzed ambits. These findings clearly demonstrate the importance of psychological symptoms in patients with the multiple drug intolerance syndrome, and show that a complex allergy and psychological work-up is mandatory in the management of these patients.

Multiple Drug Intolerance Syndrome: A Large-Scale Retrospective Study

“…Although De Pasquale et al [ 8 ] found an increased likelihood of somatisation in their MDIS cohort, we showed that rates of psychological comorbidities were similar between MDIS and non-MDIS patients. This disparity is likely to be caused by differences in methodology.…”

“…This disparity is likely to be caused by differences in methodology. We used physician-led diagnoses of psychological disorders, whereas De Pasquale et al [ 8 ] used psycho-diagnostic questionnaires to evaluate patients. Somatisation disorders have recently been identified as key risk factors for MDIS [ 9 ].…”

“…Psychological factors may also have a role to play in MDIS. Evidence suggests that MDIS patients have higher levels of anxiety, worse health-related quality-of-life scores, and increased likelihood of somatisation [ 8 , 9 ]. Such factors may have a link to the nocebo effect, which is defined as the emergence of negative effects following exposure to a nonharmful substance [ 10 ].…”

Multiple drug intolerance syndrome and multiple drug allergy syndrome: Epidemiology and associations with anxiety and depression

“…Female sex has also been identified as a risk factor for MDAS . Prior studies have suggested associations between MDIS and/or MDAS and various psychiatric comorbidities, including anxiety, depression, alexithymia, and somatization . However, to date, no clear relationship is defined.…”

Patient-Reported Allergies, a Marker of Preoperative Pain and Disability in Elective Spine Surgery

“…11 Patients with multiple drug intolerances also tend to have higher levels of anxiety, depression, and somatization. 12,13 Therefore, allergies may be associated with, or even serve as a surrogate for, Axis 1 disorders.…”