Allergic Reactions Captured by Voluntary Reporting

Abstract

Background:The epidemiology of hospital adverse reactions (ARs), particularly allergic reactions, or hypersensitivity reactions (HSRs), is poorly defined. To determine priorities for allergy safety in healthcare, we identified and described safety reports of allergic reactions. Methods:We searched the safety report database of a large academic medical center from April 2006 to March 2016 using 101 complete, truncated, and/or misspelled key words related to allergic symptoms, treatments, and culprits (e.g., medications, foods). Patient and event data were summarized for ARs and two types of ARs, HSRs and side effects/toxicities.Results: Among 9111 key word search-identified events, 876 (10%) were ARs, of which 436 (5%) were HSRs and the remaining 440 (5%) were side effect reactions or toxicities. Whereas the most common HSRs were simple cutaneous reactions (83%), the following severe immediate HSRs were also identified: shortness of breath (16%), anaphylaxis (14%), and angioedema (12%). Most HSRs were caused by drugs (81%), with antibiotics (26%), particularly β-lactams (11%), and vancomycin (8%), commonly implicated. Other causes of drug HSRs included contrast agents (24%), chemotherapeutics (7%), and opioids (6%). Nondrug HSRs were from blood products (8%), latex (3%), and devices (3%). Food reactions were rarely identified (1%). Conclusions:We identified ARs, HSRs, and side effects/toxicities, contained in a decade of safety reports at an academic medical center. Allergy safety in the healthcare setting should target approaches to common and severe reactions, with a focus on the safe administration of β-lactams, vancomycin, contrast agents, chemotherapeutics, and opioids. Priority nondrug HSR culprits include blood products, latex, and devices.

Addressing the epidemic of antibiotic “allergy” over-diagnosis

“…Stewardship efforts should be directed at avoiding unnecessary urine testing and better management strategies for elderly patients with altered mental status. 34 Blumenthal and coworkers 35 in 2019 reported on hypersensitivity reactions in a safety report database at a large academic hospital between April 2006 and March 2016. 35 They noted that 26% of all hypersensitivity reactions were associated with antibiotics.…”

“…34 Blumenthal and coworkers 35 in 2019 reported on hypersensitivity reactions in a safety report database at a large academic hospital between April 2006 and March 2016. 35 They noted that 26% of all hypersensitivity reactions were associated with antibiotics. Beta-lactams accounted for 11% and vancomycin for 8%, despite its relatively infrequent use compared with other antibiotics.…”

“…They commented that measures that would lead to less vancomycin use, such as penicillin allergy delabeling, could help reduce overall antibiotic-associated hypersensitivity events. 35…”

Development and Validation of a Deep Learning Model for Detection of Allergic Reactions Using Safety Event Reports Across Hospitals

“…[5][6][7] Given that allergic reactions can cause patient harm 8 and result in malpractice litigation, [9][10][11] timely allergic event detection, monitoring, and characterization are critical for improving health care quality and patient safety. 6,12 Hospital safety event reporting systems, which collect voluntarily reported safety event data from frontline personnel, are integral to the detection of patient safety signals in health care. 13,14 Safety reports contain a large amount of data, but still lacking are processes to analyze them in a manner that allows for timely feedback to health care professionals or actions to prevent similar future events.…”

Allergic Reactions in Two Academic Medical Centers

“…2 Improving allergic reaction recognition, management, and documentation requires improved detection and system-level targeting. We previously identified healthcare system allergic reactions using specialist-derived keyword search on safety reporting data 3 and natural language processing on clinical notes 4,5 , each followed by manual review. However, as such methods proved too time-and labor-intensive for large-scale allergy safety monitoring, we used a machine learning model to describe the epidemiology of allergic reactions at two academic medical centers (AMCs).…”