Debilitating beliefs, emotional distress and quality of life in patients given immunotherapy for insect sting allergy

Background Patients who receive immunotherapy for systemic reaction to inse ct stings are told that once they reach maintenance dose they are almost 10 0% protected against future systemic reactions. However, we have observed t hat some patients continued to perceive themselves as highly debilitated by the allergy, and this perception had a significant impact on their quality of life. Objective To validate this clinical observation and to explore possible rea sons for such an undesired psychological reaction. Methods The study group consisted of 97 patients who regularly attended an allergy outpatient clinic for venom immunotherapy, and who had been under m edical surveillance for up to 8 years. They completed a questionnaire measu ring debilitating beliefs, preoccupation with the systemic reaction event, emotional distress, perceived restriction by allergy, and perceived quality of life. We also recorded the duration of immunotherapy, physician-graded severity of the systemic reaction and the frequency at which immunotherapy was administered. The reference group consisted of patients who had not rea ched maintenance dose and were still at risk of recurrent systemic reaction s. Results As many as one-third of the patients held self-imposed debilitating beliefs, were preoccupied with the systemic reaction event, perceived a mo derate to severe impairment in their quality of life, and manifested sympto ms of emotional distress. These psychological responses did not correlate w ith the immunotherapy dosage that had been reached. Patients who reached a full maintenance dose were doing no better psychologically than those in th e reference group. Moreover, the length of time on immunotherapy did not re sult in attenuation of the psychological responses. Conclusion This study demonstrates for the first time, the long-lasting psy chological impact of a threatening systemic reaction. It suggests a need fo r intervention aimed at dispelling patients' unfounded and persisting debil itating beliefs.