Clinical Manifestations and Diagnostic Evaluation of Opioid Allergy Labels – A Review

Kalangara, Jerry P.; Potru, Sudheer; Kuruvilla, Merin

doi:10.1080/15360288.2019.1666955

Cited by 16 publications

(10 citation statements)

References 48 publications

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“…The role for skin prick testing in suspected opioid allergy is limited, although, basophil activation testing may have a role. 18 However, in many cases, a documented allergy may be well known adverse effect of opioids, such as itching without rash, constipation, nausea, and vomiting. 19 In the present study, as patient-reported data were used rather than validated measures, many of the patients who were deemed to experience ADRs to oxycodone may not actually be allergic or intolerant.…”

Section: Discussionmentioning

confidence: 99%

Opioid prescribing, pain, and hospital stay of general surgery patients with oxycodone allergies in South Australia

Kovoor,

Bacchi,

Gupta

et al. 2023

ANZ Journal of Surgery

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BackgroundThe frequency of oxycodone adverse reactions, subsequent opioid prescription, effect on pain and patient care in general surgery patients are not well known. This study aimed to determine prevalence of documented oxycodone allergy and intolerances (independent variables) in a general surgical cohort, and association with prescribing other analgesics (particularly opioids), subjective pain scores, and length of hospital stay (dependent variables).MethodsThis retrospective cohort study included general surgery patients from two South Australian hospitals between April 2020 and March 2022. Multivariable logistic regression evaluated associations between previous oxycodone allergies and intolerances, prescription records, subjective pain scores, and length of hospital stay.ResultsOf 12 846 patients, 216 (1.7%) had oxycodone allergies, and 84 (0.7%) oxycodone intolerances. The 216 oxycodone allergy patients had lower odds of receiving oxycodone (OR 0.17, P < 0.001), higher odds of tramadol (OR 3.01, P < 0.001) and tapentadol (OR 2.87, P = 0.001), but 91 (42.3%) still received oxycodone and 19 (8.8%) morphine. The 84 with oxycodone intolerance patients had lower odds of receiving oxycodone (OR 0.23, P < 0.001), higher odds of fentanyl (OR 3.6, P < 0.001) and tramadol (OR 3.35, P < 0.001), but 42 (50%) still received oxycodone. Patients with oxycodone allergies and intolerances had higher odds of elevated subjective pain (OR 1.60, P = 0.013; OR 2.36, P = 0.002, respectively) and longer length of stay (OR 1.36, P = 0.038; OR 2.24, P = 0.002, respectively) than patients without these.ConclusionsGeneral surgery patients with oxycodone allergies and intolerances are at greater risk of worse postoperative pain and longer length of stay, compared to patients without. Many still receive oxycodone, and other opioids that could cause cross‐reactivity.

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Section: Discussionmentioning

confidence: 99%

Opioid prescribing, pain, and hospital stay of general surgery patients with oxycodone allergies in South Australia

Kovoor,

Bacchi,

Gupta

et al. 2023

ANZ Journal of Surgery

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“…For penicillins, sensitivity has been reported to be low and variable (0%–50%) depending on the clinical symptoms 26 and showing false‐positive results to penicillin G in an important percentage 30 . Higher sensitivity values have been reported for NMBAs 31 : rocuronium (83%–92%), morphine (78%–84%) and suxamethonium (44%). Moreover, high‐sensitivity values (84%–97%) for sIgE to chlorhexidine, an increasingly relevant element in perioperative hypersensitivity, should be noted 32 .…”

Section: Biomarkers In Ige‐mediated Reactionsmentioning

confidence: 99%

Biomarkers of immediate drug hypersensitivity

Mayorga,

Ariza,

Muñoz‐Cano

et al. 2023

Allergy

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Immediate drug hypersensitivity reactions (IDHRs) are a burden for patients and the health systems. This problem increases when taking into account that only a small proportion of patients initially labelled as allergic are finally confirmed after an allergological workup. The diverse nature of drugs involved will imply different interactions with the immunological system. Therefore, IDHRs can be produced by a wide array of mechanisms mediated by the drug interaction with specific antibodies or directly on effector target cells. These heterogeneous mechanisms imply an enhanced complexity for an accurate diagnosis and the identification of the phenotype and endotype at early stages of the reaction is of vital importance. Currently, several endophenotypic categories (type I IgE/non‐IgE, cytokine release, Mast‐related G‐protein coupled receptor X2 (MRGPRX2) or Cyclooxygenase‐1 (COX‐1) inhibition and their associated biomarkers have been proposed. A precise knowledge of endotypes will permit to discriminate patients within the same phenotype, which is crucial in order to personalise diagnosis, future treatment and prevention to improve the patient's quality of life.

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“…Inducen activación celular mastocítica www.medigraphic.org.mx (no inmunológica) (4,13) , se limita por lo regular a prurito, urticaria e hipotensión leve y casi siempre es mal interpretada como alergia (12,15) . Hay reportes de toxicidad o «pseudoalergia» (16) , mas no de anafilaxia (17) , y su diagnóstico sigue siendo un reto, se encuentra subestimado y requiere una mirada más cercana, especialmente en la actual epidemia de consumo de opioides (5,16,18) .…”

Section: Anafilaxiaunclassified

Anafilaxia perioperatoria en el paciente pediátrico

Colín-Hernández¹,

Torres-Mata²

2022

Revista Mexicana De Anestesiología

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Clinical Manifestations and Diagnostic Evaluation of Opioid Allergy Labels – A Review

Cited by 16 publications

References 48 publications

Opioid prescribing, pain, and hospital stay of general surgery patients with oxycodone allergies in South Australia

Opioid prescribing, pain, and hospital stay of general surgery patients with oxycodone allergies in South Australia

Biomarkers of immediate drug hypersensitivity

Anafilaxia perioperatoria en el paciente pediátrico

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