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Internal Medicine Journal Nov 2022Drug allergy is commonly reported in patient notes and electronic health records. The prevalence of self-reported drug allergy in the general Australian population has...
BACKGROUND
Drug allergy is commonly reported in patient notes and electronic health records. The prevalence of self-reported drug allergy in the general Australian population has not previously been studied.
AIMS
To investigate the prevalence of self-reported drug allergy in the general adult population in South Australia.
METHODS
We surveyed a representative sample of the South Australian adult population regarding their own perception of drug allergy, including drug type and severity, as well as the use of medical alert devices. Data were weighted to correspond to age and sex of the South Australian population.
RESULTS
Twenty-two percent of adults in South Australia consider themselves allergic to one or more drugs: 9.3% declared themselves to be allergic to penicillin, 5% to an antibiotic other than penicillin and 13% to one or more antibiotics. Drug allergy and penicillin allergy was significantly more prevalent in females and increased with age. Thirteen percent of those with an antibiotic allergy reported a severe reaction, of whom 27% wore a medical notification device. Of those allergic to penicillin, 75% had their index reaction more than 10 years ago and did not report severe features.
CONCLUSION
Self-reported drug allergy is common in the general population, as it is in medical clinic and hospital populations. The majority of those reporting penicillin allergy would be considered low-risk and suitable for de-labelling procedures.
Topics: Adult; Female; Humans; South Australia; Prevalence; Australia; Drug Hypersensitivity; Penicillins; Anti-Bacterial Agents
PubMed: 34160122
DOI: 10.1111/imj.15440 -
Pediatric Annals Apr 2011
Review
Topics: Child; Drug Hypersensitivity; Eosinophilia; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Immunoglobulin E; Syndrome
PubMed: 21485996
DOI: 10.3928/00904481-20110316-07 -
Annals of the Academy of Medicine,... Nov 2022Drug allergies are often self-reported but of unknown accuracy. We carried out a prospective study to examine the utility and safety of formal allergology evaluation,...
INTRODUCTION
Drug allergies are often self-reported but of unknown accuracy. We carried out a prospective study to examine the utility and safety of formal allergology evaluation, and to identify factors associated with accurate drug allergy labels.
METHOD
All patients who underwent drug allergy evaluation in our clinic during the study period were recruited. Baseline demographics, characteristics of index hypersensitivity reaction and outcomes of evaluation were recorded.
RESULTS
A total of 331 patients from March 2019 to June 2021 completed drug allergy evaluation to index drugs of concern. There were 123 (37%) male patients, and the mean age was 49 years (standard deviation 17). There were 170 beta-lactam antibiotics, 53 peri-operative drugs, 43 others, 38 non steroidal anti-inflammatory drugs, and 27 non-beta-lactam antibiotic evaluations. Index reaction occurred within 5 years in 165 (50%) patients, with latency of less than 4 hours in 125 (38%) patients. The most common index reactions were rash, angioedema and urticaria. There were 57 (17%) evaluations stratified as low risk, 222 (67%) moderate risk, and 52 (16%) high risk based on multidisciplinary consensus. Allergy label was found to be false (negative drug evaluation) in 248 (75%) patients, while 16/237 (7%) skin tests, 44/331 (13%) in-clinic graded challenge, and 23/134 (17%) home prolonged challenges were positive (true drug allergy). The most common evaluation reactions were rash and urticaria. No cases of anaphylaxis were elicited.
CONCLUSION
Seventy-five percent of drug allergy labels are inaccurate. Risk-stratified, protocolised allergy evaluation is safe. Prolonged drug challenge increases the sensitivity of drug allergy evaluation and should therefore be performed when indicated.
Topics: Humans; Male; Middle Aged; Female; Prospective Studies; Drug Hypersensitivity; Exanthema; Urticaria; Monobactams
PubMed: 36453215
DOI: 10.47102/annals-acadmedsg.2022118 -
The Journal of Allergy and Clinical... Aug 2021In the setting of an acute cutaneous adverse drug reaction there is increasing interest in selected phenotypes and hosts to continue drug therapy, especially in settings... (Review)
Review
In the setting of an acute cutaneous adverse drug reaction there is increasing interest in selected phenotypes and hosts to continue drug therapy, especially in settings in which there are limited therapeutic options. This concept of "treating through," defined as the continued use of a drug in the setting of, in particular maculopapular exanthema, potentially avoids unnecessary drug discontinuation. A review of the recent literature, historical viewpoints, and expert opinion are provided within to form recommendations and algorithms for a "treating-through" approach.
Topics: Drug Eruptions; Drug Hypersensitivity; Exanthema; Humans; Pharmaceutical Preparations; Skin
PubMed: 33878455
DOI: 10.1016/j.jaip.2021.04.008 -
Current Opinion in Allergy and Clinical... Aug 2012Mastocytosis in adults is associated with a history of anaphylaxis in 22-49%. In addition, monoclonal mast cell activation syndrome has been described presenting with... (Review)
Review
PURPOSE OF REVIEW
Mastocytosis in adults is associated with a history of anaphylaxis in 22-49%. In addition, monoclonal mast cell activation syndrome has been described presenting with anaphylaxis, especially in patients with hymenoptera venom anaphylaxis. Data on patients with drug hypersensitivity and mast cell diseases are scarce.
RECENT FINDINGS
Drugs are elicitors of anaphylaxis in patients with mastocytosis. Drug hypersensitivity is only seldom described as associated with undetected mast cell disease in the literature. Together with a single-centred retrospective study, this data suggests that from all patients with drug-induced anaphylaxis, probably only a minority are associated with mast cell disease. Most of these cases in the literature are related to general anaesthesia. Thus, for patients with mastocytosis, general anaesthesia appears to be a procedure associated with risk of mast cell degranulation, and special precautions should be considered.
SUMMARY
The association between immediate drug hypersensitivity and undetected mast cell diseases appears to be moderate, but nevertheless basal serum tryptase determination and examination for skin signs of mast cell disorders are recommended. An ongoing European multicenter study by the European Network for Drug Allergy will provide more information on this topic.
Topics: Adult; Anaphylaxis; Anesthesia, General; Cell Degranulation; Drug Hypersensitivity; European Union; Female; Humans; Male; Mastocytosis; Multicenter Studies as Topic; Retrospective Studies; Skin; Tryptases
PubMed: 22744266
DOI: 10.1097/ACI.0b013e328355b7cb -
Arerugi = [Allergy] Jun 2012
Review
Topics: Aminophylline; Anaphylaxis; Anticonvulsants; Drug Hypersensitivity; Epinephrine; Histamine Antagonists; Humans; Immunologic Tests; Practice Guidelines as Topic
PubMed: 22868514
DOI: No ID Found -
Current Opinion in Allergy and Clinical... Aug 2017
Topics: Adult; Child; Drug Hypersensitivity; Humans
PubMed: 28598865
DOI: 10.1097/ACI.0000000000000382 -
Frequency of self-reported drug allergy: A systematic review and meta-analysis with meta-regression.Annals of Allergy, Asthma & Immunology... Oct 2017Patients reporting drug allergy are treated with second-line therapies, with possible negative clinical and health consequences. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patients reporting drug allergy are treated with second-line therapies, with possible negative clinical and health consequences.
OBJECTIVE
To assess the prevalence of self-reported drug allergy.
METHODS
We performed a systematic review of observational studies assessing the prevalence of self-reported drug allergy. We searched 4 electronic databases. From selected studies, we extracted data on self-reported drug allergy prevalence, study design, participants' demographic characteristics, reported clinical manifestations, and suspected culprit drugs. We performed a random-effects meta-analysis followed by a meta-regression.
RESULTS
Fifty-three studies were included in the systematic review, assessing a total of 126,306 participants, of whom 8.3% (range across studies 0.7-38.5%) self-reported drug allergy. Cutaneous manifestations were reported by 68.2% of participants, and anaphylactic or systemic reactions were reported by 10.8%. Antibiotics, nonsteroidal anti-inflammatory drugs, and anesthetics were the most frequently reported culprit drug classes. The frequency of self-reported drug allergy was higher in female (11.4%) than in male (7.2%) patients, adults (10.0%) than in children (5.1%), and in studies in the medical setting (15.9% in inpatients, 11.4% in outpatients) than in the general population (5.9%). The meta-analysis rendered a pooled prevalence of 7.9% (95% confidence interval 6.4-9.6), and the meta-regression identified study region, participants' age group, and study setting as factors associated with significant heterogeneity. Confirmation tests (including skin, in vitro, and drug provocation tests) were performed in only 3 studies.
CONCLUSION
The prevalence of self-reported drug allergy is highly variable and is higher in female patients, adults, and inpatients. To overcome this variability, further studies using confirmation tests are needed.
Topics: Adult; Age Factors; Anaphylaxis; Child; Drug Hypersensitivity; Europe; Female; Humans; Male; Middle East; Prescription Drugs; Prevalence; Self Report; Sex Factors; Skin; Surveys and Questionnaires; United States
PubMed: 28779998
DOI: 10.1016/j.anai.2017.07.009 -
Current Opinion in Allergy and Clinical... Aug 2002
Topics: Drug Hypersensitivity; Humans
PubMed: 12130942
DOI: 10.1097/00130832-200208000-00001 -
Immunology and Allergy Clinics of North... Aug 2009
Topics: Analgesics, Non-Narcotic; Drug Hypersensitivity; Genetic Predisposition to Disease; HLA-B Antigens; Humans; Pharmacogenetics; Polymorphism, Genetic; Stevens-Johnson Syndrome
PubMed: 19563986
DOI: 10.1016/j.iac.2009.06.002