Multiple Drug Hypersensitivity Syndrome in a Large Database

Landry, Quentin; Zhang, Shuchen; Ferrando, Laetitia; Bourrain, Jean‐Luc; Demoly, Pascal; Chiriac, Anca‐Mirela

doi:10.1016/j.jaip.2019.06.009

Cited by 32 publications

(58 citation statements)

References 39 publications

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“…This is a key factor to understand some of the diagnostic differences with other studies. Our sex and age distribution is similar to other studies that report 64.58-71.9% of females, with a mean age of 43.7-48.9 years (Doña et al, 2012;Gabrielli et al, 2018;Blanca et al, 2020). In our cohort, reactions occurred ≤1 h in 48.55% of all the patients and ≥1 h in 51.44%.…”

Section: Discussionsupporting

confidence: 89%

“…This is a drug allergy registry-based study that was done over 12-year duration. The diagnosis in our study was confirmed in 41.5% of cases, and this compares to other European studies where drug allergy was confirmed in 37.4% and not confirmed/nonallergic in 62.6% (including 13.4% with contraindications for testing) (Doña et al, 2012), and American studies, where at least one drug allergy was confirmed in 19.66% of patients (Blanca et al, 2020). This difference can be attributed to the confirmation criteria that were adapted in our study, which specifically include patients who had a positive clinical history alone.…”

Section: Discussionsupporting

confidence: 70%

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Drug Allergy Profile From a National Drug Allergy Registry

et al. 2021

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Background: Drug hypersensitivity reactions (DHRs) are among the most frequent reasons for consultation in allergy departments and are becoming more common due to increasing prevalence and case complexity.Objective: To describe the most common drugs associated with clinical reactions, diagnostic methods used, and outcomes of allergic evaluations of a national drug allergy registry over a 12-year period were used.Methods: An observational, prospective, patient’s data registry-based study was conducted to analyze all referrals to the drug allergy outpatient clinics at Al-Rashed Allergy Center, Kuwait, between 2007 and 2019. Demographics, description of DHRs, and results of allergy tests to potential causative medications were reviewed. Diagnostic methods were focused mainly on skin tests (STs) and drug provocation test (DPT), when indicated.Results: We evaluated 1,553 patients with reported DHRs. The mean age of the population was 41.52 ± 16.93 years, and the study population consisted of 63.7% female patients. Hypersensitivity was finally confirmed in 645 (41.5%) of patients, probable in 199 (12.8%), and not confirmed/nonallergic in 709 (45.6%) patients. Anti-inflammatory drugs and analgesics contributed to 39.22% of all confirmed drug allergies, followed by antibiotics 38.1% (β-lactam antibiotics (BLs) constituted 73.98% of all antibiotics and 28.21% of all drugs), anesthetics 1.8%, and radio-contrast media 0.31%. The majority of reactions were non-immediate 51.44%. The most commonly presenting symptoms among confirmed patients were urticaria 57.80%, angioedema 42.50%, respiratory symptoms 47.60%, and erythema 33.60%. Symptoms of anaphylaxis/anaphylactic shock were reported by 284 patients (44.00%) among confirmed cases. The most common method of diagnosis was a positive clinical history (54.4% in BLs and 90.45% in nonsteroidal anti-inflammatory drugs (NSAIDs). Among confirmed allergy to BLs, a positive ST was obtained in 31.9% of patients and positive DPT in 13.7%.Conclusion: NSAIDs and antibiotics, mainly BLs, are the most commonly implicated in confirmed allergy. In both confirmed and not confirmed/nonallergic cases, BLs are the most frequently involved DHRs which are mainly immediate, and the most commonly presenting symptoms were urticaria, angioedema, and respiratory symptoms. Diagnosis was confirmed mainly by a positive clinical history and when indicated, by positive STs or a DPT.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 70%

Drug Allergy Profile From a National Drug Allergy Registry

et al. 2021

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“…In a recent study in a large database, it has been confirmed that after the allergological workup, the prevalence of these reactions was 2.5% of the total suspected DHRs and 0.5% of the confirmed ones. Skin testing and drug provocation tests are mandatory for confirming the diagnosis . Moreover, this syndrome is associated with anxiety and depression, indicating the need for psychological evaluation during the allergological workup …”

Section: Diagnosismentioning

confidence: 99%

“…Skin testing and drug provocation tests are mandatory for confirming the diagnosis. 73 Moreover, this syndrome is associated with anxiety and depression, indicating the need for psychological evaluation during the allergological workup. 74…”

Section: Iag Nos Ismentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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“…This syndrome was “revived” by analyzing T‐cell reactivity of patients with drug hypersensitivity : It was noted that some patients with a T‐cell reaction to drugs (exanthema, DRESS) had a strong reactivity to more than one drug in vitro (lymphocyte transformation test [LTT]) and in vivo (mainly patch tests [PT]) . These observations were summarized in case series and defined as a drug hypersensitivity reaction (DHR) to at least 2 chemically and pharmacologically unrelated drugs . Three subforms of MDH were described according to the sequence of symptoms onset: (a) the simultaneous form, based on the appearance of symptoms to two drugs or more simultaneously (in the case of combination therapy for instance), (b) the sequential form in which subsequent reactions occur during the acute stage, and (c) the distant form when reactions occur to drugs given months to years apart .…”

Section: Introductionmentioning

confidence: 99%

The role of drug, dose, and the tolerance/intolerance of new drugs in multiple drug hypersensitivity syndrome

Jörg

Yerly

Helbling

et al. 2020

Allergy

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Background Multiple drug hypersensitivity syndrome (MDH) is used to describe persons with a drug hypersensitivity reaction (DHR) to at least two chemically unrelated drugs, confirmed by skin test or in vitro assay. Methods Medical records of 25 patients with MDH, tested and confirmed at our allergy division, were retrospectively evaluated in terms of clinical course, involved drugs, daily drug dose, latency periods, test results of skin test and cellular assays, and tolerated drugs in subsequent pharmacological treatments. Results Multiple drug hypersensitivity syndrome almost exclusively appeared as a delayed, often severe DHR and started in 14/25 with a drug reaction with eosinophilia and systemic symptoms (DRESS). Penicillins (13/25, 52.0%) and cephalosporins (6/25, 24.0%), typical high‐dose drugs, were most often identified as elicitors of MDH, especially at the first DHR, followed by aromatic antiepileptics (7/25, 28.0%), vancomycin (4/25, 16.0%), and antibiotic sulfonamides (4/25, 16.0%). Cephalosporins, clindamycin, and radio contrast media (RCM) were mainly involved in subsequent DHR. The median daily drug dose of all drug trigger was 1875.0 mg (662.5; 2100.0) at the first DHR and 600.0 mg (300.0; 1300.0) at subsequent DHR, P = .0420. Conclusion High‐dose drugs, especially beta‐lactam antibiotics, RCM and clindamycin, are common elicitors of subsequent DHR in patients with MDH. Macrolides, quinolones, doxycycline, nonaromatic antiepileptics, and paracetamol were often tolerated. As the same drugs elicited both flare‐up reactions and real DHR, drug‐induced flare‐up reactions may be precursors of a possible second DHR and MDH. The administration of highly dosed drugs should be avoided in patients at risk for MDH.

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Multiple Drug Hypersensitivity Syndrome in a Large Database

Cited by 32 publications

References 39 publications

Drug Allergy Profile From a National Drug Allergy Registry

Drug Allergy Profile From a National Drug Allergy Registry

Recent developments and highlights in drug hypersensitivity

The role of drug, dose, and the tolerance/intolerance of new drugs in multiple drug hypersensitivity syndrome

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