Disease Burden, Psychological Well-Being and Attitudes regarding the Set of Emergency Medication in Adults with Insect Venom Allergy

Abstract

Background: Insect venom allergy is common and greatly impairs patients’ quality of life. Additionally, low compliance with carrying emergency medication is reported. The aim of our study was to analyze the disease burden, levels of anxiety and depression, and to evaluate attitudes towards the set of emergency medication in affected patients. Methods: Between April 2016 and January 2017, patients ≥18 years visiting our department because of an insect venom allergy were asked to complete a paper-based questionnaire. The questionnaire assessed willingness to pay (WTP), the Hospital Anxiety and Depression Scale (HADS), subjective anxiety levels, willingness to carry the set of emergency medication, self-assurance in using it, compliance with carrying it, and reasons for not always carrying it. Results: 55 patients (81.8% wasp allergy) were included. On average, WTP for a complete cure was EUR 1,727 (median: 500). Using the HADS, 14.5% showed definite anxiety disorders while 5.5% had significant depression disorders. Most patients stated to carry the emergency medication “always” (25.5%) or “almost always” (47.3%). “Forgetfulness” (36.4%) was reported as the main reason for not always carrying the medication, followed by “too big” (18.2%). Conclusions: In our patient cohort, insect venom allergy was associated with a moderate disease burden and a good compliance with carrying the emergency medication. However, several of our participants demonstrated borderline or significant anxiety and/or depression disorders. In this regard, this study highlights the necessity to regularly ask the patient about the psychological well-being to identify patients needing psychological support.

Sex Differences in Adults with Insect Venom Allergy regarding Psychological Distress, Attitudes toward the Emergency Medication, and Factual Knowledge about the Disease

“…Female HVA patients have a higher subjective anxiety level than male patients and are more inclined to carry the EMS "always" or "almost always" with them, but have lower self-assurance in using it. In our previous analysis of our study data, we did not find significant differences regarding anxiety and depression levels between female and male HVA patients in the HADS-A and HADS-D [8]. Interestingly enough, when asked to define their subjective anxiety level due to the venom allergy on a VAS (0 = not anxious at all, 10 = extremely anxious), female patients had a mean value of 7.2, while the mean score in men was 4.6.…”

“…Studies investigating for an association between HVA and quality of life as well as patients' compliance with the prescribed EMS are sparse. Thus, in our previous study, we investigated the disease burden, psychological well-being, and attitudes regarding the set of emergency medication in 55 HVA patients [8]. Here, HVA was associated with a moderate disease burden and good compliance with carrying the emergency medication.…”

Impact of specific immunotherapy and sting challenge on the quality of life in patients with hymenoptera venom allergy

“…Cohort stringency concerning age, gender, and insect allergy is provided compared to other cohorts. 25 , 29 Whereas in the present population the number of female patients slightly prevails, epidemiologic data show a higher prevalence of sensitization to hymenoptera venom in males. 30 The rate of patients allergic to either bee or yellow jacket venom can vary depending on the degree of exposure.…”

“…However, the distinct and rather small sample sizes might be a possible confounder, and we suggest a reevaluation with a bigger cohort. As for anxiety, ambiguous findings exist in terms of its correlation with severity of the anaphylactic reaction: while Schaarschmidt et al 29 did not find an association between these parameters, Cichocka-Jarosz et al 32 revealed a significant correlation in their cohort. Still, we conclude that treatment indications for VIT should not only be based on the severity of the reaction, but should also include an assessment of the QoL.…”

“…No significant correlation was detected between state of treatment and depression or anxiety scores. Schaarschmidt et al 29 showed that neither the status of VIT nor the duration of VIT had an influence on anxiety in their cohort, while Nowak et al 13 demonstrated a decreased intensity of anxiety under VIT. Interestingly, one study 25 reported a post-SC increase in depression, measured by the General Severity Index of the Brief Symptom Inventory.…”