Self‐reported drug allergies and the diagnostic work‐up in the surgical population

Abstract

Objective The diagnostic work-up of a drug hypersensitivity reaction is indeed difficult. In general, medical documentation of allergic reactions in medical reports is usually highly deficient or non-existent. The aim of this study was to analyse the prevalence of selfreported drug allergies in the surgical population as well as the criteria used in the diagnosis of drug hypersensitivity reactions. Methods A prospective study with the consecutive participation of 1439 patients, following surgical intervention, attended the Post-Operative Care Unit. Previously, as a routine process during the pre-anesthesia consultation, all patients were questioned about whether they had any drug allergies to report and diagnostic work-up. Results The prevalence of self-reported drug allergies was 8.3% (119/1439): 3.6% considered themselves allergic to b-lactams and 2.4% to non-steroidal anti-inflammatory drugs. Approximately one-third of the subjects (40 out of the 119) had not been subjected to any allergy diagnostic procedure and with 79 (66.4%), the only diagnostic test used by the Allergy Unit had been the skin prick-test. None of those participating in the study had tryptase, methylhistamine, specific IgE or intradermal tests carried out to characterize the diagnosis of the allergic reaction. Conclusions These results show that self-reported drug allergies are highly prevalent and as yet little explored. It is an important prevalence which should bring about modifications to the prescription of certain medicaments. The medical personnel must be made aware of the need to make an accurate diagnosis of allergies to medicaments.

DALES, Drug Allergy Labels in Elective Surgical patients: a prospective, multicentre cross-sectional study of prevalence, nature and anaesthetists’ approach to management

“…[15][16][17] Drug allergies were most commonly reported to antibiotics, NSAIDs and opioids and were more common in older, female patients. These findings are in keeping with previous studies [8][9][10][11][12][13][14] but the reasons for them are unknown. One possibility is that older patients have had a greater number of potentially sensitising drug exposures, with antibiotics and analgesics some of the most frequently used drugs.…”

“…Other studies suggest a prevalence ranging from 7-38%, with antibiotics, non-steroidal anti-inflammatories (NSAIDs) and opioids the most frequently reported culprits. [8][9][10][11][12][13][14] It is widely accepted that a significant proportion of drug allergy labels are incorrect, with side effects or other non-allergic phenomena misattributed to allergy by patients or their healthcare providers. [15][16][17] We aimed to determine the prevalence of patient-reported drug allergies in the UK elective surgical population and risk stratify the reported reactions for likelihood of genuine allergy.…”

Primary care doctors' attitude towards drug allergy in Portugal: a questionnaire

“…Similar or even lower rates are reported by numerous other publications. 26,27,28,29 In our opinion, GPs do not consider the immediate impact of using second line therapies (efficacy, adverse effects, antibiotic resistances), and more importantly do not perceive the need for long term clinical decisions.…”

Preoperative evaluation of patients with history of allergy

“…Depending on study population, definition of drug allergy and other factors, the reported incidence has been between 7,8% (in general population) and 39% (in surgical population). 13,14,15 Unfortunatelly, the proportion of patients who underwent further investigation following the adverse reaction is less than 30-50% and it has been shown that between 40-50% of them are confirmed as being allergic. 16 Patients with self-reported allergies most commonly considered themselves allergic to antibiotics (more than 40% to penicillins and other βlactams), NSAIDs, opioids, iodine, diuretics, etc.…”