ABSTRACT
BACKGROUND: Basic mechanisms of pseudoallergic drug reactions as well as a possible role of the psyche are currently unknown. OBJECTIVE: Examination of psychological status and reactions during diagnostic provocation tests in patients with previous pseudoallergic reactions to drugs. SUBJECTS AND METHODS: Ten inpatients, admitted for provocation tests, were studied in a double-blind, placebo-controlled setting, with inventories of anxiety and depression being measured at baseline and psychological reactions and symptoms being recorded daily by patients and the attending physician. RESULTS: Patients reported more than twice as many symptoms as the physician, independent of the type of exposure. While the basic psychological profile of the patients was normal, anxiety trait and state values were high during testing, with a significant increase depending on whether the patients thought they had received a drug or a placebo. Similarly, frequency of symptoms was dependent on the patients' perception of the type of exposure. CONCLUSION: These findings demonstrate a high level of anxiety during systemic provocation tests in patients with previous pseudoallergic drug reactions, raising serious questions as to the diagnostic validity of the routine application of this testing.
Subject(s)
Anxiety/diagnosis , Depression/diagnosis , Drug Hypersensitivity/psychology , Ampicillin/adverse effects , Anesthetics/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Double-Blind Method , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Humans , Personality Assessment , Psychological TestsABSTRACT
OBJECTIVE: To estimate ratios of pulmonary-to-systemic blood flows (Qp/Qs) after stage I palliation (Norwood operation) for hypoplastic left heart syndrome and to determine whether early postoperative death can be associated with abnormalities of Qp/Qs ratios. DESIGN: Retrospective. SETTING: University hospital. PARTICIPANTS: Patients who underwent stage I palliation (Norwood operation) for hypoplastic left heart syndrome (n = 76). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The results of the last intraoperative blood gas analysis were compared between patients who survived the day of operation (58 of 76) and the patients who died intraoperatively or within 4 hours after operation (18 of 76). Qp/Qs ratios were calculated using the Fick principle from arterial and venous oxygen saturations at estimated pulmonary venous oxygen saturation of 95%. A lower arterial oxygen saturation (SaO(2), 69.0 +/- 20.5% v 77.3 +/- 8.5%; p < 0.05) and more marked metabolic acidosis (pH, 7.244 +/- 0.115 v 7.298 +/- 0.095; p < 0.05; base excess, -6.8 +/- 4.4 v -3.0 +/- 4.2; p < 0.05) were observed in nonsurvivors. Calculated Qp/Qs ratios ranged between 0.2 and 6.5 in survivors and between 0.6 and 1.9 in nonsurvivors. CONCLUSIONS: Postoperative excessive pulmonary blood flow was not implicated as a cause of death based on blood gas data and Qp/Qs ratios. In nonsurvivors, low cardiac output and hypoxemia were assumed to be major problems.
Subject(s)
Hypoplastic Left Heart Syndrome/surgery , Oxygen/blood , Palliative Care , Acid-Base Equilibrium , Arteries , Female , Humans , Hypoplastic Left Heart Syndrome/metabolism , Hypoplastic Left Heart Syndrome/mortality , Hypoplastic Left Heart Syndrome/physiopathology , Infant , Infant, Newborn , Male , Pulmonary Circulation , Pulmonary Veins , Retrospective Studies , Survival RateABSTRACT
In order to examine the diagnostic value of systemic provocation tests, we studied 56 inpatients hospitalized for identification of the agent eliciting previous severe allergic or pseudoallergic reactions to non-steroidal anti-inflammatory drugs, local anaesthetics or antibiotics. Skin tests were positive in only 4 patients reacting to antibiotics and propyphenazone and were always negative for local anaesthetics (n = 32). Only 4 of 26 patients reacted to oral or subcutaneous provocation, 3 times to penicillin and once each to mepivacain, propyphenazone and cyanocobalamine when the suspected drug was tested. In the remaining 30 patients, who for safety reasons were tested only with alternative drugs, none had positive reactions, but 11 patients reported non-specific symptoms, as did 9 of 21 patients given placebo. Systemic provocation tests for drug allergy thus gave few positive results. However, these tests should always be done together with placebo testing for validation of results, and they remain indispensable for identification of alternative, well-tolerated drugs.
Subject(s)
Drug Hypersensitivity/diagnosis , Adult , Anesthetics, Local/adverse effects , Anti-Bacterial Agents/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Diagnosis, Differential , Female , Humans , Male , Predictive Value of Tests , Skin TestsABSTRACT
In a multicenter study, 100 patients with chronic urticaria were examined with a standardized personality test (Giessen test), a standardized symptom questionnaire (Giessener Beschwerdebogen) and a specially developed questionnaire concerning symptoms, history and behaviour during symptomatic periods. Almost one third of the patients showed elevated scores both for depression and for symptoms that are often associated with depression. It therefore seems worth-while examining such persons more specifically and possibly treating them by psychosomatic methods. The present results do not allow the classification of chronic urticaria as a somatization disorder. Since one-third of the patients had symptoms of depression, combined dermatological and psychosomatic approach may make it possible to offer them an appropriately targeted treatment.
