Prevalence of self-reported drug hypersensitivity reactions among Lithuanian children and adults

Kvedarienė, Violeta; Šitkauskienė, Brigita; Tamašauskienė, Laura; Rudzevičienė, Odilija; Kasiulevičius, Vytautas; Nekrosyte, G.; Gomes, Eva; Demoly, Pascal

doi:10.1016/j.aller.2018.05.006

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…Regarding drug classes, we found that the most implicated group of drugs were antibiotics (8.7%), particularly beta-lactams, and NSAIDs (3.3%), which is very similar to a recent study where 5.8% of patients self-reported allergy to antibiotics, and 1.5% to NSAIDs (7).…”

Section: Discussionsupporting

confidence: 89%

The impact of a drug allergy label in an internal medicine ward

Coelho¹,

Santos²,

Mikovic³

et al. 2023

Eur Ann Allergy Clin Immunol

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Drug hypersensitivity reactions are presumably immune-mediated reactions that cause reproducible signs and/or symptoms. Overdiagnosis of drug allergy, frequently self-reported, is common and carries significant limitations. We intended to analyze the frequency and impact of drug allergy in hospitalized patients.A retrospective study was conducted in an Internal Medicine ward at a tertiary hospital in Portugal. All patients with a drug allergy report admitted within a 3-year period were included. Data were collected from their electronic medical records.We found that 15.4% of patients had a report of drug allergy, with antibiotics being the most common (56.4%), followed by non-steroidal anti-inflammatory drugs (21.7%) and radiocontrast media (7.0%). The allergy report affected the clinical approach of 14.5% of patients by motivating the use of second-line agents, or the eviction of necessary procedures. The usage of alternative antibiotics entailed a cost increase of 2.4 times. There were 14.7% of patients to whom the suspected drug was administered: 87.0% tolerated and 13.0% developed a reaction. Only 1.9% were referred to our Allergy and Clinical Immunology department and proceeded in their allergy study.In this study, a considerable number of patients had a drug allergy label on their records. This label contributed to an increase in the cost of treatment, or the avoidance of necessary exams. However, disregarding an allergy record may lead to potentially life-threatening reactions that proper risk assessment could avoid. Further investigation should always be part of the follow-up routine of these patients, and better articulation between departments should be encouraged.

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Section: Discussionsupporting

confidence: 89%

The impact of a drug allergy label in an internal medicine ward

Coelho¹,

Santos²,

Mikovic³

et al. 2023

Eur Ann Allergy Clin Immunol

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“…Our study also confirmed that about 1 in 18 (5.61%) of Hong Kong's population have physician-reported drug allergies, which differs quite substantially with other regions (especially in Western cohorts), as well as our own previous hospital-based studies. 8,[22][23][24][25][26] Although drug allergy prevalence varies across time and region (likely due to combination of differing prescribing practices and biological differences) we postulate discrepancies may also arise due to previous type I errors from inadequate sampling, which would be minimised from this population-wide study. This needs to be confirmed by collaborative inter-regional and -ethnic big data studies in the future.…”

Section: Discussionmentioning

confidence: 90%

Disproportionate drug allergy labelling among middle-aged patients and barriers to excipient allergy testing from the Hong Kong Comprehensive Excipient and Drug Allergy Registry (CEDAR)

Chiang

Kan

Chinmoy

et al. 2023

Preprint

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Background: Longitudinal whole-population studies can explore new dimensions in drug allergy research. Excipient allergy testing remains a barrier to allergy evaluation in countries without legislations mandating ingredient disclosure in registered drugs. The Comprehensive Excipient and Drug Allergy Registry (CEDAR) was established to investigate Hong Kong’s drug allergy landscape and potential role of excipient registries. Methods: Drug allergy data from over 7,337,778 individuals between 2016-2021 was analyzed. Excipient lists were gathered from all formulations of the top 50 reported drug allergies and checked for the presence of polyethylene glycol (PEG). Results: The absolute-prevalence and -incidence of reported drug allergy was 5.61% and 277/100,000 population in 2021, respectively. Annual incidence of newly reported drug allergy was stable between 2016-2019, until a significant drop in 2020 (-16.3%, p=0.037). The most common implicated drugs were anti-infectives (245,832 [44.5%]), NSAIDs (106,843 [19.3%]), and nervous system drugs (45,802 [8.3%]). There was significant higher incidence among individuals aged >40, contributing to the majority of newly reported allergies (377,004, 68.2%). Beta-lactams and nervous system drugs were the most common reported culprits of anaphylaxis and Stevens-Johnson syndrome. CEDAR was unable to confirm presence or absence of PEG in any of the top reported culprits due to insufficient excipient information. Conclusion: We report the detailed drug allergy landscape of the Hong Kong population. Excipient registries are ineffective in countries without mandatory excipient listings . Contrary to traditional doagma, we identified a disproportionately higher incident drug allergy among middle-aged and older patients. Findings need to be confirmed by region-specific big data studies.

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“…This is thought to be multifactorial, including hormonal influences on mast cell receptors, shared exposure to sensitizing agents, differing perceptions of risk, and medication use. 22,23 The commonest allergic AEFI in this cohort was a delayed urticarial rash and generalized puritis with or without angioedema, with onset usually a day or up to 21 days following vaccination (Fig 2). In the ENSEMBLE study, 8 versus 5 cases of urticaria were reported in active versus placebo arms of the phase III study; unfortunately, timing of onset postdosing was not reported.…”

Section: Discussionmentioning

confidence: 92%