Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper

Abstract

The strongest and best‐documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross‐reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper‐based documentation.

Recent developments and highlights in drug hypersensitivity

“…A common problem in the management of DHRs may be the repeated prescribing of known drugs that account for 8%‐15% of the medication errors worldwide. To avoid this, EAACI has recommended the use of drug allergy cards to facilitate the communication of patients' drug allergy history, especially during emergency situations. This has decreased recurrent RCM hypersensitivity reactions .…”

Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics

“…Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics 145 Example of an allergy passport (in German). For a patient with maculopaplar exanthema to amoxicillin for whom beta-lactams with an amino group in the R1 side chain (ampicillin, cefaclor, cephalexin, cefadroxil) were prohibited due to anticipated cross-reactivity, but who exhibited tolerance to the central beta-lactam ring structure and an unrelated cephalosporin side chain at skin testing and provocation testing with penicillin V and cefuroxime [148] In vitro testing has the advantage for the patient that there is no risk of allergic reactions as a result of diagnostic testing. Reliable cellular in vitro testing methods need to be further developed and evaluated.…”

Sepsis like acute hypersensitivity syndrome related to mesna

“…Fever associated with hypersensitivity reactions due to the neoplastic and biologic agents has been reported. [4][5][6][7] These symptoms typically occur within 1-6 h after the last drug administration. Immediate allergic reactions develop as a result of IgE synthesis after sensitization.…”