Department of Biomedical Sciences, College of Natural Science and Department of Health Sciences, The Graduate School of Dong-A University, Busan, South Korea.
Department of Allergy and Clinical Immunology, Cheju Halla General Hospital, Doreongno 65, Jeju-si, Jeju, Republic of Korea.
J Med Case Rep. 2023 Jul 28;17(1):341. doi: 10.1186/s13256-023-03937-7.
Panic disorder and panic attacks are two of the most common problems in psychiatry. A psychoimmunological correlation between allergic diseases and panic disorder has been strongly suggested. Histamine H1 receptor antagonists have been suggested as alternative drugs for the treatment of panic disorder. Chronic spontaneous urticaria (CSU) and panic disorder improved simultaneously with selective serotonin reuptake inhibitor antidepressants. Panic disorder has also been treated with the antihistamine chlorpheniramine. The immunoglobulin/histamine complex is a histamine-fixed immunoglobulin preparation that was reported to be effective in treating CSU. This case report describes the successful treatment of a patient with concomitant panic disorder and CSU for 23 years using immunoglobulin/histamine complex therapy.
This report describes a 52-year-old female Korean patient who suffered from CSU with panic disorder for 23 years. Basic allergy tests (blood tests and skin prick tests) were conducted before and after treatment for the evaluation of allergic conditions. A multiple allergosorbent test (MAST) for the detection of allergen-specific IgE levels was also performed. The clinical severity of CSU was evaluated using the urticaria severity score system. Diagnostic interviews systematically assessed the diagnostic criteria outlined by the DSM-V, and the patient was evaluated before, during and after treatment using the Beck Depression Inventory (BDI-2) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety and the Beck Hopelessness Score (BHS) for hopelessness. The patient received 2 ml of Histobulin™ (12 mg human immunoglobulin/0.15 µg histamine complex) once a week by subcutaneous injection for the treatment of CSU. Initial improvement of CSU was achieved after the third injection. After the twenty-seventh injection of Histobulin™, she showed no symptoms or signs and ceased allergic medication use. With the remission of CSU, allergic rhinitis was also completely resolved. The frequency of the common cold was significantly decreased during and after treatment. The medication frequency and development of clinical manifestations of panic disorder changed in parallel with the clinical severity of CSU. Moreover, the patient exhibited no clinical manifestations and ceased medication for panic disorder and sleeping pills for insomnia simultaneously with the remission of CSU. In the psychological evaluation, the BDI, STAI and BHS scores improved accordingly.
The immunoglobulin/histamine complex was effective in treating CSU and concomitant panic disorder in this patient and could be effective in treating some types of panic disorder. Considering the mechanisms of action of histamine and the immunoglobulin/histamine complex together with the patient's clinical progress, histamine seemed to be related to panic disorder in this case. The concept of histamine-mediated syndromes, including allergies and psychiatric disorders, shows that a wider disease identity may be needed. Further studies on the immunopathogenesis of panic disorder and the mechanisms of action of the immunoglobulin/histamine complex are necessary.
恐慌症和恐慌发作是精神病学中最常见的问题之一。过敏疾病与恐慌症之间存在强烈的心理免疫学相关性。组胺 H1 受体拮抗剂已被提议作为治疗恐慌症的替代药物。慢性自发性荨麻疹 (CSU) 和恐慌症同时通过选择性 5-羟色胺再摄取抑制剂抗抑郁药得到改善。抗组胺药氯苯那敏也用于治疗恐慌症。免疫球蛋白/组胺复合物是一种组胺固定免疫球蛋白制剂，据报道可有效治疗 CSU。本病例报告描述了一名同时患有恐慌症和 CSU 的 52 岁韩国女性患者，使用免疫球蛋白/组胺复合物治疗 23 年成功治愈。
本报告描述了一名 52 岁的韩国女性患者，患有 CSU 和恐慌症 23 年。在治疗前后进行了基础过敏测试（血液测试和皮肤点刺测试），以评估过敏情况。还进行了多过敏原吸附试验 (MAST) 以检测过敏原特异性 IgE 水平。使用荨麻疹严重程度评分系统评估 CSU 的临床严重程度。诊断访谈系统地评估了 DSM-V 中列出的诊断标准，在治疗前、治疗期间和治疗后使用贝克抑郁量表 (BDI-2) 评估抑郁、状态-特质焦虑量表 (STAI) 评估焦虑和贝克绝望量表 (BHS) 评估绝望。患者每周接受一次皮下注射 2ml HistobulinTM（12mg 人免疫球蛋白/0.15µg 组胺复合物）治疗 CSU。第三次注射后，CSU 得到初步改善。接受 HistobulinTM 第 27 次注射后，她没有任何症状或体征，停止了过敏药物的使用。随着 CSU 的缓解，过敏性鼻炎也完全消退。在治疗期间和治疗后，普通感冒的频率明显降低。恐慌症的药物治疗频率和临床表现的发展与 CSU 的临床严重程度平行变化。此外，随着 CSU 的缓解，患者同时停止了恐慌症和失眠症的药物治疗和安眠药的使用。在心理评估中，BDI、STAI 和 BHS 评分相应提高。
免疫球蛋白/组胺复合物对该患者的 CSU 和并发恐慌症有效，可能对某些类型的恐慌症有效。考虑到组胺和免疫球蛋白/组胺复合物的作用机制以及患者的临床进展，组胺在这种情况下似乎与恐慌症有关。过敏和精神疾病等与组胺相关的综合征的概念表明，可能需要更广泛的疾病特征。有必要进一步研究恐慌症的免疫发病机制和免疫球蛋白/组胺复合物的作用机制。
