Drug allergy management in the elderly

Abstract

Purpose of reviewDrug allergy management has previously not been emphasized in the elderly. However, the geriatric population poses several unique characteristics, challenges for drug allergy testing and considerations in the management. Especially in the era of COVID-19, the elderly population is a vulnerable cohort and reviewing the management during this unprecedented time is both timely and relevant. Recent findingsIn recent years, larger scale studies focusing on the epidemiology and prevalence trends of drug allergies among older adults has been summarized in this review. Emphasis on anaphylaxis in the older adults has been studied.

Prevalence and impact of misdiagnosed drug allergy labels among patients with hereditary angioedema

“…Three DA labels, including: “traditional Chinese medicine” (unable to retrieve formulation), “oral contraceptive pill” (relatively contraindicated for HAE patients) and “contrast” (unable to identify index contrast used) were excluded for analysis. Nine (22%) HAE patients carried at least one DA label, this prevalence is higher than that of the general population (14%) and comparable to patients with rheumatoid arthritis and systemic lupus erythematosus in our previous published cohorts ( 6 , 8 ). Comparison of DA label prevalence among different patient cohorts is shown in Table 2 .…”

“…Every 1 in 15 of the population of Hong Kong have at least one physician reported DA label; most commonly to beta-lactams (BL) antibiotics, non-BL antibiotics and non-steroidal anti-inflammatory drugs (NSAID) ( 4 – 7 ). Many of these DA labels, especially for BL, are found to be inaccurate after formal allergy workup and have been associated with a variety of adverse clinical outcomes ( 4 – 6 , 8 – 10 ). Due to the lack of Specialists in Immunology & Allergy in Hong Kong, suspected DA are seldom investigated or revisited and most patients live with misdiagnosed “allergy” labels for the rest of their lives ( 11 , 12 ).…”

Differences in beta-lactam and penicillin allergy: Beyond the West and focusing on Asia-Pacific

“…Among those labelled with BL allergy, the obligatory use of less effective and more harmful second-line antibiotics is associated with poorer clinical outcomes such as higher admission rates, in-hospital mortality, and risk of infection from multidrug resistant organisms (including Clostridioides difficile , methicillin-resistant Staphylococcus aureus , and vancomycin-resistant Enterococcus ) ( 9 – 11 ). These adverse outcomes are especially accentuated among vulnerable and immunocompromised individuals, such as patients with underlying immunological diseases and the elderly ( 9 , 11 , 12 ). In the era of COVID-19, patients with BL allergy labels were shown to have higher rates of ICU admission, acute respiratory failure, need for mechanical ventilation and overall mortality ( 13 , 14 ).…”

Editorial: Advances in drug hypersensitivity reactions

“…With aging populations and the extensive use of medication to treat multiple co-morbidities there are increasing rates of hypersensitivity reactions in elderly patients. Wong et al review the assessment of the elderly population [9]. They report antibiotics and nonsteroidal anti-inflammatory drugs to be the two commonest drug classes to cause hypersensitivity.…”

“…Patient recall is often less reliable, especially when some time has passed since the time of the reaction. There is little evidence in the literature regarding management in this population; however, Wong et al suggest age should not be a barrier and future research is needed to assess the efficacy of skin testing and the safety of provocation tests in elderly patients [9].…”