Journal of the Romanian Society of Allergology and Clinical Immunology  Vol. XIII, No.

3, July - September 2016

original articles and brief communications

Cognitive coping role in the

management of patients with a history of
immediate-type hypersensitivity to drugs
Doina Colcear1, Nadia Onițiu-Gherman1
1
“Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

ABSTRACT
A history of immediate-type hypersensitivity reactions to drugs may cause distress and maladaptive coping
(mechanisms) interfering with the therapeutic act.
The latest international guidelines acknowledge the role of stress and anxiety in relation to allergic events, but
do not define cognitive factors involved in maladaptive coping (mechanisms/types) (“NICE clinical guideline
183”, 2014; “International Consensus on drug allergy”, 2014).
Objective: to identify cognitive coping (types) in patients with a history of drug allergy returning to the
allergist on their own initiative (functional behavior) compared to those returning to the allergist forced by
circumstances (illness, investigations, etc.) (dysfunctional behavior).
Participants: 25 patients in the functional group and 25 patients in the dysfunctional group.
Results: The functional group showed significant correlations between the perceived severity of previous
allergic reactions and the cognition type positive refocusing’ (p = 0.0550). The dysfunctional group presented,
compared with the functional group, more frequent beliefs (coping mechanisms) like: self-blame (p = 0.0244),
catastrophizing (p = 0.0328), acceptance (p = 0.0336), refocusing on planning (p = 0.0277), positive re-evalu-
ation (p = 0.0004), putting into perspective (p = 0.0298) and a higher correlation between the negative expec-
tations about the risk of a new allergic incident and the total (p = 0.0289) and dysfunctional (p = 0.0291)
distress.
Conclusions: the differences between the functional behavior (returning to the allergist of oneself) and the
dysfunctional behavior (returning to the allergist forced by circumstances) can be partially explained by the
cognitive coping.
KEYWORDS: Immediate-type hypersensitivity; Drugs; Coping; Cognitions

Corresponding Author: Doina Colcear

“Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, Surgery I Department;
E-mail: colceardoina@gmail.com
Submission date: 19/08/2016; Acceptance date: 15/09/2016; Publication date: 15/10/2016

19
Journal of the Romanian Society of Allergology and Clinical Immunology 
original articles and brief communications
Introduction
The history of immediate-type hypersensitivity reac-
tions to drugs (DHRs) generates, depending on their
intensity, different degrees of emotional distress.
Immediate DHRs include urticaria, angioedema, rhini-
tis, conjunctivitis, bronchospasm, gastrointestinal
symptoms [nausea, vomiting, diarrhea, and abdominal
pain], anaphylactic shock; they typically occur within
1– 6 h after the last drug administration (Demoly P. et
al., 2014).
The need to use new drugs reactivates in these pati-
ents, irrational beliefs related to previous emotional
distress and dysfunctional behaviors (maladaptive co-
ping) that may interfere with their management (e.g.
denial, resignation, fatalism) (Iamandescu and
Diaconescu, 2010).
Latest guidelines and international consensus
acknowledge the role of stress and anxiety related to
allergic events and that the hypersensitivity reactions
to drugs is more likely related to the patients’ psycho-
logical profile; they make recommendations for coun-
seling but do not show exactly which psychological
factors are involved in generating these events and do
not refer to coping strategies involved in these cases
(“NICE clinical guideline 183, Drug allergy Diagnosis
and management of drug allergy in adults, children and
young people Clinical guideline 183 Methods, evidence
and recommendations”, 2014; “International Consensus
on drug allergy”, 2014).
Background
There have been numerous studies that have shown
the involvement of psychological factors in the imme-
diate hypersensitivity reactions to drugs (drug aller-
gies) (Demoly et al., 2005, 2014; Diaconescu, 2006,
2007; Gomes et al., 2004, 2005; Iamandescu, 1993,
1999, 2002, 2003, 2004, 2009, 2010; Johansson et al.,
2004; Kamei et al., 1998; Kovacs and Arato, 1997; Ziffra
and Gollan, 2009). They have demonstrated that there
is an important psychological component associated to
both the onset and the maintenance of the hypersensi-
tivity reactions to drugs so that after a severe allergic
incident psychic vulnerability is generated that can be
further responsible for an inappropriate perception of
a new hypersensitivity or intolerance reaction to drugs
is generated.
The problem of maladaptive coping (mechanisms/
types) is intensely debated internationally. Lazarus et
20
Vol. XIII, No. 3, July - September 2016
al. (1984, 1987) divided coping types into two major
categories: problem focused coping (direct coping) and
emotion-centered coping (indirect coping). Even if the
division mentioned is generally accepted, it poses a
problem of decoding coping strategies, as it doesn’t hi-
ghlight the role of cognition in generating the two
broad categories of coping (“what you think” vs. “what
you do”) (Holahan, Moss and Bonin, 1999). Even
though in recent years the relationship between coping
(strategies/types) and psychopathology was clearly de-
fined (Compas et al., 2001; Endler and Parker, 1990;
Thoits, 1995), it is unclear to what extent certain influ-
ences could be specifically attributed to cognitive as-
pects in the sense that nobody knows exactly how beli-
efs influence coping directly and indirectly. It is assu-
med that cognitive strategies refer to patients’ styles of
coping with negative life events, which are non-supe-
rimposable with personality traits because in some
cases people use specific cognitive strategies that differ
from the strategies they would otherwise use. It is also
assumed that the cognitive coping strategies can be
affected, changed, learned or forgotten, for example,
through psychotherapy, intervention programs or indi-
vidual experiences. In order to influence the patients’
cognitive coping it was necessary to have the tools to
evaluate the cognitive components of emotion regula-
tion in adolescents and/or adults. It was observed that
no such instruments were available (Garnefskiet al.,
2001). Following that observation, the Cognitive
Emotion Regulation Questionnaire (CERQ) was develo-
ped (Garnefski et al., 2001; Garnefski, Kraaij and
Spinhoven, 2002). Further studies carried out by
Garnefski et al. (2002, 2003), using CERQ, showed that
a large measure of Rumination, Catastrophizing, and
Self-blame was associated with the presence of psycho-
pathological symptoms. These seemingly maladaptive
coping (strategies/types) can be, therefore, an impor-
tant factor in the prevention and / or management of
the emotional response to the negative life events.
CERQ calibration on the Romanian population was
made in 2010 (Garnefski N, Kraaij V, Spinhoven P,
Perțe A and Țincaș I, 2010).
Aim of the study/ objectives
Assessment of the disparities between the percep-
tion of the seriousness of the previous immediate-type
hypersensitivity reactions to drugs, perception of the
allergy reassessment risk, cognitive coping strategies
(cognitive emotion regulation), the distress generated
by the re-evaluation of the drug hypersensitivity in pa-
tients with a functional coping type (coming for re-
 Cognitive coping role in the management of patients with a history of immediate-type hypersensitivity to drugs
evaluation “on their own initiative”) and the same items
for patients who present a dysfunctional coping type
(coming for re-evaluation “forced by circumstances”
due to surgery, illness, investigations, etc.).
The working assumption
Based on the results obtained by Garnefski et al.
(2002, 2003) using the Cognitive Emotion Regulation
Questionnaire (CERQ), which showed that a large mea-
sure of Rumination, Catastrophizing, and Self-blame is
associated with the presence of psychopathological
symptoms, we expect significant differences between
the cognitive coping (types) in the group returning to
the allergist on their own initiative (functional beha-
vior) compared with the group returning to the aller-
gist forced by circumstances (illness, investigations,
etc.) (dysfunctional behavior).
To verify the assumption, we proceeded to make the
following statistical analysis:
1. correlation analysis between the real severity
grade and the perceived seriousness of the previ-
ous immediate-type hypersensitivity reactions to
drugs in patients who come to the re-evaluation
“on their own initiative” compared with patients
who come to re-evaluation “forced by circumstan-
ces”;
2. correlation analysis between the perception of the
severity of the previous immediate-type hypersen-
sitivity reactions to drugs and cognitive coping
(cognitive emotion regulation) in patients who
come for the re-evaluation „on their own initia-
tive” compared with patients who come for re-
evaluation „forced by circumstances”;
3. c orrelation analysis between the expectations of
the risk for a new immediate-type hypersensitivity
reaction to drugs and the emotional distress be-
fore re-evaluation in patients who come to re-eva-
luation “forced by circumstances” compared with
patients who come for re-evaluation “on their own
initiative”;
4. c omparison between the 2 groups with regard to
cognitive coping (types).
Method
Participants:
There were included in the study 50 patients with a
history of immediate-type hypersensitivity reaction to
medication. They were divided into 2 groups:
GROUP A - included 25 patients who presented to
21
the Allergy Center for the (re)assessment of immedi-
ate-type hypersensitivity to drugs on their „own initia-
tive”;
GROUP B - included 25 patients who presented to
the Allergy Center for the (re)assessment of immedi-
ate-type drug hypersensitivity “forced by circumstan-
ces” (illness, investigations, etc.).
Patients were randomly included in the study, in the
order of their arrival into the Allergy Center. Pre-study,
patients were informed about the study objectives,
about the issues related to privacy and protection of
personal data and, after that, they signed the Informed
Consent Form.
a. Inclusion criteria:
- Patients with a history suggestive of an immediate-
type hypersensitivity reaction (regardless of severity
and regardless of the drug); the symptoms assessment
utilized the ENDA drug allergy questionnaire (Demoly
et al., 1999);
- Adults (≥18 years) at the time of enrollment.
b. Exclusion criteria:
- pregnancy;
- treatment with antihistamines or other medicati-
ons that interfere with the allergologic diagnostic tests
accuracy, acute allergic reaction at presentation.
Measurement tools:
- 5 standardized tests were used (licensed) (recogni-
zed by the Romanian College of Psychologists). They
were chosen to operationalize psychological constructs
described in the objective and formulated hypothesis.
We used the following tests:
TEST 1: - a numerical assessment scale of the per-
ception of the seriousness of the previous immediate-
type hypersensitivity reactions to drugs (1 to 10);
TEST 2: - a numerical scale for assessing expectati-
ons of a risk for new immediate-type hypersensitivity
reactions to drugs (during the re-evaluation of the drug
allergy)(1 to 10);
TEST 3: - Cognitive Emotion Regulation
Questionnaire (CERQ) (Cognitrom licence) – a multi-
dimensional questionnaire, designed to identify cogni-
tive coping types, which one uses after experiencing
negative life events or situations. In contrast to other
questionnaires on coping, which do not make a clear
distinction between a person’s thoughts and behavior,
CERQ refers exclusively to a person’s thoughts after ha-
ving lived a negative experience. Psychometric data:
CERQ is a self-evaluation questionnaire with 36 items
Journal of the Romanian Society of Allergology and Clinical Immunology 
original articles and brief communications
and 9 rating scales for assessing Cognitive coping stra-
tegies (Self-blame, Acceptance, Rumination, Positive re-
focusing, Refocus on planning, Positive reappraisal,
Putting into perspective, Catastrophizing, Other-blame)
and is targeting the children and adults of normal and
clinical populations. For the different sub-scales in the
various populations, Cronbach’s alpha coefficients are
good to very good (in most cases more than 0.70 and in
many cases even more than 0.80). Regarding the homo-
geneity of scales, most correlations between items and
the rest of the scale are well above 0.40, while the lowest
value does not fall below 0.35 which confirms that no
item can be classified as inappropriate and/or proposed
for exclusion (Garnefski et al., Manual for the use of
the Cognitive Emotion Regulation Questionnaire,
2010);
TEST 4: - Emotional Distress Profile questionnaire
(PDE)(RTS licence) - a questionnaire designed to iden-
tify the perceived emotional distress of the patient
BEFORE re-evaluating of the hypersensitivity to drugs;
PDE is a scale with 26 items that measure functional
negative emotions (“concern”, “sadness”) and dysfunc-
tional negative emotions (“anxiety/fear”, “depression”)
(David D, 2012). The test can be used both for persons
without psychopathology and for those with various
forms of psychopathology and has two components:
total distress (PDE-TOT) and dysfunctional distress
(PDE-disf ). It is recommended for use in people over
14 years, in normal and clinical populations;
TEST 5: - same PDE questionnaire in order to iden-
tify the perceived emotional distress to the patient
AFTER re-evaluating the hypersensitivity to drugs.
Research design
Non-experimental descriptive and correlational cli-
nical trial
Methodology
Study duration: 3 months.
Location: A llergy Center of the Clinical Emergency
C o u nt y Ho s p i t a l C l u j - Na p o c a ,
Coordinator of the Allergy Center:
Lecturer Nadia Oniţiu- Gherman,
Allergist MD
Steps:
Step 1. Preliminary
Obtaining the approvals:
22
Vol. XIII, No. 3, July - September 2016
- Ethics Committee Approval no. 224/ 01.06.2016 in
order to conduct the study within the Clinical
Emergency County Hospital, Cluj-Napoca, Allergy
Centre;
- Ethics Committee Approval no. 64 / 03.14.2016 of
the “Iuliu Hațieganu” University of Medicine and
Pharmacy, Cluj-Napoca for the design of the study and
report.
Preparation of the documentation: Consent Forms,
Questionnaires.
Database establishment: The database was establi-
shed using the MICROSOFT EXCEL program so as to
contain the following items (columns):
a. personal data: name (initial), gender, age, origin
(urban/rural areas)
b. reason for the re-evaluation of the immediate-
type hypersensitivity to drugs:
• version 1 = “own initiative”
• version 2 = “forced by circumstances”
c. The severity of the allergic drug incident from the
patient’s history: urticaria; angioedema; hypotension;
bronchospasm/dyspnea; anaphylactic shock; the grade
of severity for quantification of immediate hypersensi-
tivity reactions, included: the grade I reactions (cuta-
neous signs: generalized erythema, urticaria, angioe-
dema), grade II (measurable but not life-threatening
symptoms as cutaneous signs, hypotension, tachycar-
dia, respiratory disturbances: cough, difficulty
inflating), grade III (life-threatening symptoms:
collapse, tachycardia or bradycardia, arrhythmias,
bronchospasm) and grade IV (cardiac and/or respira-
tory arrest) (Mertes et al., and the Working Group of
the SFAR and SFA and W Aberer et al. for END and the
EAACI Interest Group on Drug Allergy, 2011)
Step 2. Patient Selection
Patients were randomly selected in order of their
presenting to the Allergy centre, based on inclusion
criteria. Those included were adults (≥18 years) co-
ming from urban and rural areas.
Step 3. Administration of tests
After initial patients’ training on the objectives of
the study and after obtaining the patients’ signatures on
The Informed Consent forms, patients were handed Test
1, 2, 3, 4 (before reevaluation of the hypersensitivity
reactions to medicines); Test 5 was handed after re-
assessing the drug hypersensitivity.
Step 4. Collection of tests, scoring and introducing
the scores in the database
Step 5. Statistical analysis
Statistical analysis was performed with software
Statistics v. 8 at a significance level of 5%, so p < 0.05
 Cognitive coping role in the management of patients with a history of immediate-type hypersensitivity to drugs

Group 1 = Own initiative Group 2 = Forced by cir- p (difference between

Variables
(n=25) cumstances (n=25) groups)

Gender– n(%) 0.2184

F (female) 22 (88.00) 20 (80.00)
M (male) 3 (12.00) 5 (20.00)
p (difference between < 0.0001 < 0.0001
F and M)

Provenience – n(%) 0.1017

Rural 4 (16.00) 1 (4.00)
Urban 21 (84.00) 24 (96.00)
p (difference between < 0.0001 < 0.0001
rural and urban)

Age (years) – average ±

47.04±16.55 52.40±15.34 0.2409
standard deviation

Table 1. Demographic characteristics and differences between groups

Group 2 = Forced by cir- p (difference between

Group 1 = Own initiative
cumstances groups)

Urticaria 12% 20% 0.6366

Angioedema 24% 40% 0.2184

Hypotension 4% 0% 0.3093

Bronchospasm/dyspnea 28% 0% 0.0018

Anaphylactic shock 32% 40% 0.7651

Table 2. Distribution of the previous immediate-type hypersensitivity reactions to drugs

was considered statistically significant (p = probability Results

of obtaining results, considering that null hypothesis is
true; if p < 0.05 the null hypothesis is rejected and re-
search hypothesis is accepted). Parametric tests were
used for continuous variables and nonparametric tests
for discrete variables (nominal or ordinal).
Demographic characteristics and differences
between the 2 groups in terms of gender and origin are
summarized in Table 1.
Distribution of the previous immediate-type hyper-

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Journal of the Romanian Society of Allergology and Clinical Immunology  Vol. XIII, No. 3, July - September 2016

ORIGINAL ARTICLES AND BRIEF COMMUNICATIONS

Group 1 = Own initiative (n=25) Group 2 = Forced by circumstances (n=25)

Spearman p-level Spearman p-level

PSA-U & T1 -0.3414 0.0948 -0.4336 0.0304

PSA-A & T1 -0.3213 0.1173 0.0354 0.8666

PSA-hTA & T1 0.2086 0.3170 n.a. n.a.

PSA-BPD & T1 -0.0585 0.7811 n.a. n.a.

PSA-AS & T1 0.5007 0.0108 0.3854 0.0571

PSA= previous severity grade of allergic reaction

T1(Test 1)= the perception of the seriousness of the previous immediate-type hypersensitivity reaction to drugs
U= urticaria; A= angioedema; HTA= hypotension; BPD=bronchospasm/dyspnea; AS= anaphylactic shock
n.a= Not available (it cannot be calculated because there are no PAI-HTA and PAI-BPD subjects in group 2)

Table 3. Correlation between real seriousness and the perception of the seriousness of the previous immediate-type hypersensitivity reaction to drugs

Group 1 = Own initiative (n=25) Group 2 = Forced by circumstances (n=25)

Spearman p-level Spearman p-level

T3-SB & T1 -0.2285 0.2720 0.0169 0.9361

T3-AC & T1 0.2628 0.2044 -0.2340 0.2602

T3-RU & T1 0.1162 0.5802 -0.0172 0.9351

T3-PR & T1 0.3884 0.0550 0.0905 0.6670

T3-REP & T1 0.2113 0.3105 0.1262 0.5477

T3-PREA & T1 0.0962 0.6473 -0.2563 0.2162

T3-PP & T1 -0.2535 0.2214 -0.2682 0.1950

T3-CA & T1 -0.0540 0.7975 0.0020 0.9924

T3-OB & T1 -0.0962 0.6474 -0.2086 0.3170

T3 (Test 3)= Cognitive Emotion Regulation Questionnaire (CERQ)

SB=Self-blame, AC=Acceptance, RU=Rumination, PR=Positive refocusing, REP=Refocus on planning, PREA=Positive reappraisal, PP=Putting
into perspective, CA=Catastrophizing, OB=Other-blame

Table 4. C
 orrelation analysis between the perception of the severity of the previous immediate-type hypersensitivity reactions to drugs (T1) and cognitive
coping (cognitive emotion regulation) (T3-)

24
 Cognitive coping role in the management of patients with a history of immediate-type hypersensitivity to drugs
sensitivity reactions to drugs is presented in Table 2. In
group 2 the most common incidents were allergic angi-
oedema (40%) and anaphylactic shock (40%) and in
group 1 the most frequent was a history of anaphylactic
shock (32%). Hypotension (4%) and bronchospasm/
dyspnea (28%) were identified solely in group 1.
Bronchospasm/allergic dyspnea was the only incident
in history significantly more frequent in group 1 versus
group 2 (p = 0.0018)
Statistical analysis performed in order to verify the
assumption
1. Correlation analysis between the real severity grade
and the perception of the seriousness of the previous
immediate-type hypersensitivity reactions to drugs in pa-
tients who come for re-evaluation on “own initiative”
compared with patients who come for re-evaluation “for-
ced by circumstances” (Table 3).
- in group 1 (own initiative), we found a strong and
positive correlation (statistically significant) between
the real seriousness and the perception of the serious-
ness of the previous immediate-type hypersensitivity
reactions to drugs in patients who have had anaphyla-
xis (p = 0.0108);
- in group 2 (forced by circumstances), we found a
strong and negative correlation (statistically signifi-
cant) between the real seriousness and the perception
of the seriousness of the previous immediate-type
hypersensitivity reactions to drugs in patients who
have had urticaria (p=-0.4336).
2. Correlation analysis between the perception of the
severity of the previous immediate-type hypersensitivity
Group 1 = Own initiative (n=25)
Spearman
T4 PDE-TOT & T2 0.1649
T4 PDE-disf & T2 0.1880
T2 (Test 2) = a numerical scale used for assessing expectations of a risk for new immediate-type hypersensitivity reactions to drugs
T4 PDE- TOT = total distress evaluated with T4
T4 PDE-disf = dysfunctional distress evaluated with T4
Table 5. C
 orrelation analysis between expectations of a risk for a new immediate-type hypersensitivity reaction to drugs (T2) and total distress (T4 PDE-TOT),
respectively dysfunctional distress (T4 PDE-disf)
reactions to drugs (T1) and cognitive coping (type)(cog-
nitive emotion regulation) (T3-) in patients who come
for the re-evaluation on „own initiative” compared with
patients who come to re-evaluation „forced by circum-
stances” (Table 4).
- in group 1 (own initiative) we didn’t find statistically
significant correlations except the correlation between
T1 and beliefs of „positive refocusing” (p = 0.0550 );
- in group 2 (forced by circumstances) we didn’t find
any statistically significant correlations.
3. Correlation analysis between expectations of a risk
for a new immediate-type hypersensitivity reaction to
drugs (T2) and the emotional distress before re-evalua-
tion (T4) in patients who come for re-evaluation “forced
by circumstances” compared with patients who come for
re-evaluation “on their own initiative” (Table 5).
We found a positive correlation (statistically signifi-
cant) in group 2 between expectations of a risk for a
new immediate-type hypersensitivity reaction to drugs
and total/dysfunctional distress (T4 PDE-TOT/ T4
PDE-disf ).
4. Comparison between the 2 groups with regard to
cognitive coping strategies (T3) (Table 6).
When comparing cognitive coping (T3-) between
the 2 groups we found statistically significant differen-
ces (more pronounced in group 2) in the following cog-
nitions: SB=Self-blame (p=0.0244), AC=Acceptance
(p=0.0336), REP=Refocus on planning (p=0.0277),
PREA=Positive reappraisal (p=0.0004), PP=Putting into
perspective (p=0.0298) and CA=Catastrophizing
(p=0.0328).
Group 2 = Forced by circumstances (n=25)
p-level Spearman p-level
0.4308 0.4372 0.0289
0.3681 0.4365 0.0291
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Journal of the Romanian Society of Allergology and Clinical Immunology  Vol. XIII, No. 3, July - September 2016

ORIGINAL ARTICLES AND BRIEF COMMUNICATIONS

T3-SB T3-AC T3-RU T3-PR T3-REP T3-PREA T3-PP T3-CA T3-OB

Group 1 average 3.52 4.84 4.48 4.96 4.72 4.68 5.04 5.32 3.60

stdev 1.81 1.93 2.06 2.19 2.19 1.60 1.59 1.68 1.61

median 3 4 5 6 5 5 5 6 4

Q1 2 4 3 3 4 4 4 5 2

Q3 5 7 6 7 7 6 6 6 5

Group 2 average 4.96 5.96 5.44 5.88 6.12 6.16 6.00 6.12 4.08

stdev 2.44 1.27 1.64 1.67 1.05 1.57 1.15 1.39 1.89

median 6 7 6 7 7 7 6 7 4

Q1 4 5 4 5 5 6 5 6 2

Q3 7 7 7 7 7 7 7 7 5

p 0.0244 0.0336 0.1031 0.1253 0.0277 0.0004 0.0298 0.0328 0.3773

T3 (Test 3) = Cognitive Emotion Regulation Questionnaire (CERQ)

SB=Self-blame, AC=Acceptance, RU=Rumination, PR=Positive refocusing, REP=Refocus on planning, PREA=Positive reappraisal, PP=Putting
into perspective, CA=Catastrophizing, OB=Other-blame
average = average of the frequencies
stdev = standard deviation
median =mean part of the series
Q1 = quartile 1 (inferior 25% of the series), Q3= quartile 3 (superior 25% of the series)

Table 3. Correlation between real seriousness and the perception of the seriousness of the previous immediate-type hypersensitivity reaction to drugs

Discutions nal factors generated by the need for reevaluation.

Significant differences in terms of gender (more
women than men; p <0.0001) and in terms of place of
origin (more patients in urban than rural areas p
<0.0001) correspond to the data in the literature
(Barranco and Lopez-Serrano, 1998; Bernard and Teck-
Choon Tan, 2011; Kando and Yonkers, 1995; Haddi et
al., 1990). A possible explanation for the increased
frequency in women is that they use more antibiotics
than men (Macy and Poon, 2009).
Correct assessment of the gravity of anaphylactic
shock in both groups can be explained by the fact that
this is most easily assessed; “paradoxical” assessment of
Urticaria in group 2 can be explained by lack of
knowledge in the field or by other cognitive or emotio-
The fact that PR=Positive refocusing was found to
be correlated with positive coping in functional group
1, partially validates the hypothesis that these patients
frequently encounter positive cognitions which cor-
responds with the results of Garnefski et al., 2010;
Positive refocusing occurs when we think of more
pleasant things, instead of thinking about the negative
events of life.
The positive correlation (statistically significant) in
group 2 between expectations of a risk for a new imme-
diate-type hypersensitivity reaction to drugs and total/
dysfunctional distress can be explained by the fact that
they did nothing to clarify their hypersensitivity to
drugs and now they are again faced with this problem
plus the new issue of a medical nature.

26
 Cognitive coping role in the management of patients with a history of immediate-type hypersensitivity to drugs
The fact that patients in the group 2 had more dys-
functional cognitions like Self-blame and Catastrophizing
than patients in group 1 corresponds to the results obtai-
ned by Garnefski et al. (2002, 2003). More “functional”
cognitions at group 2 like Acceptance, Refocus on plan-
ning, Positive reappraisal and Putting into perspective can
be interpreted as a cognitive coping strategy that reduces
the emotional distress of the moment (feeling better) wi-
thout generating a functional behaviour leading to the
clarification of the medical situation (getting better).
Conclusions
The fact that some significant differences were iden-
tified between the 2 groups regarding perception of the
severity of the previous immediate-type hypersensitivity
reactions to drugs, regarding cognitive coping related to
the perception of the previous allergic incident (signifi-
cant for “positive refocusing” in group 1), regarding
emotional distress related to expectations of a new aller-
gic incident at re-evaluation (higher in group 2) and re-
garding the cognition types (higher in group 2) can
allow us to say that the assumption of the study is parti-
ally validated. Further studies are necessary to a com-
plete validation of the hypothesis that there are signifi-
cant differences between cognitive coping mechanisms
in the group returning to the allergist on their own ini-
tiative (functional behavior) compared with the group
returning to the allergist forced by circumstances (ill-
ness, investigations, etc.) (dysfunctional behavior).
Acknowledgement
The questionnaires used were licensed and were do-
nated by dr. Doina Colcear, psychiatrist, practicing
psychotherapist without other financial implications
for patients, for “Iuliu Hatieganu” University of
Medicine and Pharmacy, Cluj-Napoca or Emergency
County Hospital, Cluj- Napoca.
Conflicts of interests: The authors declare no conflicts of interests..
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