<b><i>Introduction:</i></b> Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) is reported to be the most common drug hypersensitivity. The aim of this study was to evaluate the characteristics of self-reported NSAID hypersensitivity and identify patients at high risk of NSAID hypersensitivity. <b><i>Methods:</i></b> Patients who presented at a single tertiary care hospital between January–December 2017 with reported NSAID hypersensitivity were evaluated. Clinical information obtained from a review of medical records was further supplemented with data gained from a telephone-administered questionnaire. <b><i>Results:</i></b> From a total of 535 patients with reported NSAID hypersensitivity, 301 were included in the study. The mean age of onset of NSAID hypersensitivity reaction was 30.3 ± 14.9 years old. A total of 84 patients (27.9%) were hypersensitive to 2 or more chemically unrelated NSAIDs. The leading NSAID hypersensitivity was to propionic acid derivatives (73%) followed by acetic acid derivatives (28.9%). Immediate reaction (≤1 h) was identified in 171 patients (57.8%), and angioedema was the most frequently reported symptom (179 patients, 59.5%), followed by urticaria and anaphylaxis in 85 (28.2%) and 62 (20.6%) patients, respectively. A drug provocation test was performed on 53 patients, and NSAID hypersensitivity was confirmed in 38 patients (71.6%). The independent factors identified, which could predict NSAID hypersensitivity, were personal history of allergic rhinitis/chronic rhinosinusitis (AR/CRS), onset of NSAID hypersensitivity over 15 years old, and immediate reaction. <b><i>Conclusion:</i></b> Angioedema was the most typical symptom, and propionic acid derivatives were the most frequently reported culprit drugs. The significant risk factors predicting NSAID hypersensitivity were personal history of AR/CRS, onset of NSAID hypersensitivity reaction over 15 years old, and immediate reaction.
RATIONALE: About 10% of patients report allergy to penicillin. Of those patients evaluated with a penicillin skin test (ST) and challenge, 90-99% are able to tolerate penicillin, resulting in penicillin allergy de-labeling. However, while patients are often de-labeled in the short term, factors that predict the persistence of penicillin allergy de-labeling remain unknown. METHODS: A retrospective chart review was conducted on patients evaluated for penicillin allergy from 2012-2017(inpatient and outpatient). Data was collected from the electronic medical record (EMR), pharmacy records, as well as a follow-up telephone survey with patients. RESULTS: Thirty-three patients were successfully de-labeled of their penicillin allergy (negative ST and tolerated oral challenge). One-third of these patients had persistence of their penicillin allergy in the EMR (11/ 33), and 7 patients had persistence in their pharmacy records (21%). Persistence of the penicillin allergy label was not significantly associated with age (p50.73), gender (p50.35), or whether the evaluation was done inpatient or outpatient (p50.88). Follow-up telephone survey was done with 24 patients (nine patients were unavailable for follow-up), and 96% (n523) recalled the results of their allergy evaluation correctly. Despite accurate recall, 3 patients continued to avoid penicillin for fear of a possible reaction. CONCLUSIONS: This study found that while penicillin allergy delabeling is safe and effective, there is a discrepancy between the allergy evaluation and the appropriate removal of the penicillin allergy from the EMR and pharmacy records, which may include patient apprehension as a cause. Neither age, gender, nor place of evaluation predicted persistence of the penicillin allergy label.
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