Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Abstract

Background Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco‐economics of MDAS and MDIS. Methods Systematic literature search across 11 databases (01 January 2000–06 November 2020) for MDIS, MDAS and related terminology. Studies were reviewed for quality of evidence and risk of bias by employing Critical Appraisal Skills Programme cohort study checklist. A narrative synthesis approach facilitated by systematic textual descriptions, tabulation and thematic analysis was adopted. Results There was heterogeneity in terminology and methodology. Few studies applied standard drug allergy diagnostic methods. There is some evidence to suggest that multiple drug hypersensitivity syndrome (MDHS; i.e., confirmed allergies in MDAS) is a distinct clinical entity. Prevalence of MDIS and MDAS labels in unselected & selected populations varied between 2.1%–6.4% & 4.9%–90% and 1.2% & 0%–36% respectively. Reported risk factors included female gender, increasing age, body mass index, anxiety, depression, co‐morbidities, concurrent allergies and increased healthcare utilization. Drugs commonly implicated were antibiotics and non‐steroidal anti‐inflammatory drugs. No studies relating to clinical impact and pharmaco‐economics were found. Conclusion There is considerable burden of MDAS and MDIS labels. Data needs cautious interpretation as majority of studies described involved unverified labels. Despite this limitation and heterogeneity of studies, there is some evidence to suggest that MDHS is a distinct clinical entity. Well‐designed multi‐centre studies applying standardized terminology and diagnostic methodology are needed to gain further insight into these conditions.

Internalizing disorders as a mediator of the association between adverse childhood experiences and perceived medication intolerance or poly-allergy

“…Previous studies have developed social and psychological profiles of patients who are more likely to have poly-allergies using medical record data, but have not accounted for a tendency to catastrophize. These studies show that poly-allergy patients share many of the same characteristics as patients with higher ACES, including, more likely to be: Female, older, obese or overweight, higher utilizers of healthcare services 10 – especially inpatient services, have multiple medical comorbidities, 10 depressed or have depression, 11 anxious or have anxiety, 12 and more neurotic or have higher rates of neuroticism. 13 Meanwhile, most of these studies rely on the use of medical records and thus do not include measures of trauma exposure.…”

Delabelling multiple antibiotic allergy: Practical issues

“…For example, patients may be incorrectly labelled with multiple antibiotic allergies which severely limits future antibiotic prescription, especially should patients require antibiotics to treat acute infections, pre-operative or pre-procedural antimicrobial prophylaxis or long-term antimicrobial suppressive therapy ( 1 ). The terms multiple drug hypersensitivity syndrome [MDHS and multiple drug intolerance syndrome (MDIS) are distinct entities which have been clearly defined in the literature] ( 2 – 5 ). The benefits of antibiotic allergy delabelling is best exemplified with beta-lactam (in particular penicillin) allergy, which is often incorrectly and over-diagnosed ( 6 – 9 ).…”