Importance of hypersensitivity in adverse reactions to drugs in the elderly

Abstract

BackgroundThe use of drugs in the elderly is very extensive because of the frequent occurrence of chronic diseases. Adverse drug reactions (ADRs) commonly occur in geriatric patients receiving multiple therapeutic regimens. In the literature, little attention has been given to ADRs in the elderly, and particularly to allergic reactions.ObjectiveThe aim of the present study is to provide data on possible inappropriate prescriptions in the elderly in relation to allergic reactions and to identify a list of drugs which are likely inducers of allergic reactions.MethodsWe retrospectively evaluated ADRs in patients referring to Immunoallergy Unit of Hospital Policlinico in Bari on the basis of Beers criteria. Among adverse reactions, hypersensitivity reactions were extracted and a comparison between different age groups was assessed.ResultsOut of 823 patients with ADRs, in 30.6% hypersensitivity drug reactions (HDR) were diagnosed. Data about drug intake, comorbidities and clinical presentation were collected, aiming to identify possible risk factors. An evaluation of drugs most commonly involved was assessed.ConclusionsHDR are reported to represent 5–10% of all ADRs, while in our study population the prevalence was about 30%. This suggests the need to develop strategies to minimize the incidence of drug allergy in the elderly, as well to reduce the phenomenon of inappropriate prescriptions.

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

“…Antibacterials for systemic use (~53%) and anti‐inflammatory/antirheumatic products together with analgesics (~19%) were the most frequently reported suspected drugs in the database. These results are in line with findings from other investigations . Penicillins and NSAIDs (eg acetylsalicylic acid, ibuprofen and diclofenac) were particularly implicated, whereas tramadol and metoclopramide also deserve attention.…”

“…These results are in line with findings from other investigations. 26 TA B L E 4 (Continued) of ATC) in a considerable proportion of cases (n = 95; 20.5%). This is probably because the healthcare professionals who report the cases were not necessarily the prescribers of suspected drugs, which could make it difficult the access to that information.…”

Recent developments and highlights in drug hypersensitivity

“…Age, and specifically the elderly, has gained attention since DHR prevalence increases up to 30%, being more severe, probably due to comorbidities and the use of multiple medications, which suggests the need for strategies to minimize this incidence such as the reduction of inappropriate prescriptions …”

“…29 Age, and specifically the elderly, has gained attention since DHR prevalence increases up to 30%, being more severe, probably due to comorbidities and the use of multiple medications, which suggests the need for strategies to minimize this incidence such as the reduction of inappropriate prescriptions. [30][31][32] New genetic associations in DHRs have been found 33,34 ( Table 2) the cost-effectiveness of the screening of these markers to prevent SCARs prior to prescription of some drugs in specific populations.…”

Management of anaphylaxis due to COVID‐19 vaccines in the elderly

“…[19][20][21] Anaphylaxis in older people is not uncommon and is often more severe than in younger adults. 22 Vaccinations are known to cause anaphylaxis, although very rarely. 23,24 The benefit of the vaccination clearly outweighs the risk of severe anaphylaxis reaction to the COVID-19 vaccines, even in older people suffering from severe allergic diseases.…”