Psychological burden in anaphylaxis: a study on alexithymia and quality of life

This study examines the impact of psychological burden on quality of life (QoL) in patients with anaphylaxis, assessing the relationship between alexithymia, QoL, and the presence of anxiety or depression.

A total of 29 patients with a confirmed diagnosis of anaphylaxis and a prescription for self-injectable epinephrine were recruited. Their QoL, psychological stress levels, and potential presence of anxiety, depression, and alexithymia were assessed using validated questionnaires: The Anaphylaxis Quality of Life Scale for Adults (A-QoL-Adults), the World Health Organization Quality of Life Scale - Brief Version (WHOQoL-BREF), the Perceived Stress Scale (PSS), the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), and the Toronto Alexithymia Scale (TAS-20). Scores were compared, and statistical analyses were conducted.

Of the 29 patients who completed the questionnaires, 11 (37.9%) were classified as alexithymic or borderline alexithymic. A moderate positive correlation was observed between TAS-20 scores and perceived anaphylaxis severity (r = 0.435, p = 0.021), with alexithymic/borderline alexithymic patients reporting significantly higher severity compared to non-alexithymic patients (high severity: 35.3% non-alexithymic vs. 81.8% alexithymic/borderline alexithymic, p = 0.016). TAS-20 scores showed a strong positive correlation with HADS-D scores (r = 0.518, p = 0.006) and a strong negative correlation with Environmental-WHOQoL-BREF scores (r = -0.501, p = 0.008). Additionally, moderate positive correlations were found between TAS-20 scores and HADS-A (r = 0.408, p = 0.035), A-QoL-Adults (r = 0.487, p = 0.009), and its subscales SQoL (r = 0.477, p = 0.01) and LoL (r = 0.479, p = 0.01). Finally, TAS-20 scores exhibited a moderate negative correlation with Psychological-WHOQoL-BREF scores (r = -0.501, p = 0.008).

This study underscores the significant correlation between alexithymia and QoL in patients with anaphylaxis. Integrating psychological assessments into anaphylaxis management may enable healthcare providers to develop more comprehensive strategies beyond physical symptom control. A holistic approach-including education, emotional support, and psychological interventions-could enhance long-term outcomes for patients prescribed epinephrine auto-injectors.