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Journal of Patient Safety Dec 2021The epidemiology of hospital adverse reactions (ARs), particularly allergic reactions, or hypersensitivity reactions (HSRs), is poorly defined. To determine priorities...
BACKGROUND
The epidemiology of hospital adverse reactions (ARs), particularly allergic reactions, or hypersensitivity reactions (HSRs), is poorly defined. To determine priorities for allergy safety in healthcare, we identified and described safety reports of allergic reactions.
METHODS
We searched the safety report database of a large academic medical center from April 2006 to March 2016 using 101 complete, truncated, and/or misspelled key words related to allergic symptoms, treatments, and culprits (e.g., medications, foods). Patient and event data were summarized for ARs and two types of ARs, HSRs and side effects/toxicities.
RESULTS
Among 9111 key word search-identified events, 876 (10%) were ARs, of which 436 (5%) were HSRs and the remaining 440 (5%) were side effect reactions or toxicities. Whereas the most common HSRs were simple cutaneous reactions (83%), the following severe immediate HSRs were also identified: shortness of breath (16%), anaphylaxis (14%), and angioedema (12%). Most HSRs were caused by drugs (81%), with antibiotics (26%), particularly β-lactams (11%), and vancomycin (8%), commonly implicated. Other causes of drug HSRs included contrast agents (24%), chemotherapeutics (7%), and opioids (6%). Nondrug HSRs were from blood products (8%), latex (3%), and devices (3%). Food reactions were rarely identified (1%).
CONCLUSIONS
We identified ARs, HSRs, and side effects/toxicities, contained in a decade of safety reports at an academic medical center. Allergy safety in the healthcare setting should target approaches to common and severe reactions, with a focus on the safe administration of β-lactams, vancomycin, contrast agents, chemotherapeutics, and opioids. Priority nondrug HSR culprits include blood products, latex, and devices.
Topics: Anti-Bacterial Agents; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans
PubMed: 30720546
DOI: 10.1097/PTS.0000000000000568 -
Journal of Paediatrics and Child Health Aug 2022Penicillin allergy accounts for the majority of all reported adverse drug reactions in adults and children. Foregoing first-line antibiotic therapy due to penicillin...
AIM
Penicillin allergy accounts for the majority of all reported adverse drug reactions in adults and children. Foregoing first-line antibiotic therapy due to penicillin allergy label is associated with an increased prevalence of infections by resistant organisms and longer hospitalisation. Clinician awareness of allergy assessment, referral indications, management of allergy and anaphylaxis is therefore vital but globally lacking. We aim to assess the knowledge of penicillin allergy, assessment and management in Western Australian health professionals.
METHODS
An anonymous survey was distributed to pharmacists, nurses and physicians within Western Australian paediatric and adult Hospitals, Community and General Practice.
RESULTS
In total, 487/611 were completed and included in the statistical analysis. Only 62% (301/487) of respondents routinely assessed for patient medication allergies. Of those who assessed allergy, 9% (28/301) of respondents met the Australian standards for allergy assessment. Only 22% (106/487) of participants correctly cited all indications for management with adrenaline in anaphylaxis to antibiotics and 67% (197/292) of physicians rarely or never referred to an allergy service. Paediatric clinicians had an increased understanding of allergy assessment and anaphylaxis management. Recent penicillin allergy education within a 5-year period led to significant improvements in allergy knowledge.
CONCLUSION
Overall, knowledge, assessment and management of penicillin allergies among practitioners in Western Australia are currently inadequate in adults and paediatric clinicians to provide safe and effective clinical care. The implementation of a targeted education program for WA health professionals is urgently required and is expected to improve clinician knowledge and aid standardised penicillin assessment (de-labelling) practices.
Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Australia; Child; Drug Hypersensitivity; Hospitals; Humans; Penicillins; Surveys and Questionnaires
PubMed: 35502826
DOI: 10.1111/jpc.16007 -
British Journal of Anaesthesia Jun 2012Local anaesthetic (LA) agents have been routinely used in dentistry, ophthalmology, minor surgery, and obstetrics since the late nineteenth century. Reports relating to... (Review)
Review
Local anaesthetic (LA) agents have been routinely used in dentistry, ophthalmology, minor surgery, and obstetrics since the late nineteenth century. Reports relating to adverse reactions and LA allergy have appeared in the published literature for several years. However, the incidence of true, IgE-mediated LA allergy remains uncertain and is presumed to be very low. We critically reviewed the English language literature on suspected LA allergy and its investigation with the aim of estimating the reported prevalence and analysing the role of different tests currently used to identify and confirm LA allergy. Twenty-three case series involving 2978 patients were identified and analysed. Twenty-nine of these patients had true IgE-mediated allergy to LA, thus confirming the reported prevalence of LA allergy in large series to be <1% (0.97%). The protocols used in the investigation of these patients have also been discussed. Evidence from this review confirms the rarity of IgE-mediated allergy to LA and supports an investigation strategy based on using the clinical history to select patients for skin testing and challenge. We believe that such a triage process would alleviate pressures on allergy services without compromising patient safety.
Topics: Anesthetics, Local; Cross Reactions; Drug Hypersensitivity; Humans; Immunoglobulin E; Skin Tests; United Kingdom
PubMed: 22593127
DOI: 10.1093/bja/aes162 -
Allergology International : Official... Dec 2012Angioedema is the end result of deep dermal, subcutaneous and/or mucosal swelling, and is potentially a life-threatening condition in cases where the pharynx or larynx... (Review)
Review
Angioedema is the end result of deep dermal, subcutaneous and/or mucosal swelling, and is potentially a life-threatening condition in cases where the pharynx or larynx is involved. Drug-induced angioedema has been reported to occur in response to a wide range of drugs and vaccines. Drug-induced angioedema, like other cutaneous drug reactions, has been reported to be most frequently elicited by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs, although reliable data from epidemiologic studies are scarce. Recent reports suggested an increasing role of angiotensin-converting enzyme inhibitors (ACEIs) in the causation of life-threatening angioedema. ACEI-related angioedema is never accompanied by urticaria and occurs via a kinin-dependent mechanism. ACEI-related angioedema not only can start years after beginning the treatment, but it can then recur irregularly while under that treatment. Furthermore, allergy tests are unreliable for the diagnosis of ACEI-related angioedema, and so the relationship between angioedema and ACEIs is often missed and consequently quite underestimated. Accordingly, better understanding of the kinin-dependent mechanism, which is particular to angioedema, is necessary for the appropriate management of drug-induced angioedema.
Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Drug Hypersensitivity; Humans
PubMed: 23183389
DOI: 10.2332/allergolint.12-RAI-0493 -
The Korean Journal of Internal Medicine Feb 2022Drug desensitization is the temporary induction of tolerance to a sensitized drug by administering slow increments of the drug, starting from a very small amount to a... (Review)
Review
Drug desensitization is the temporary induction of tolerance to a sensitized drug by administering slow increments of the drug, starting from a very small amount to a full therapeutic dose. It can be used as a therapeutic strategy for patients with drug hypersensitivity when no comparable alternatives are available. Desensitization has been recommended for immunoglobulin E (IgE)-mediated immediate hypersensitivity; however, its indications have recently been expanded to include non-IgE-mediated, non-immunological, or delayed T cell-mediated reactions. Currently, the mechanism of desensitization is not fully understood. However, the attenuation of various intracellular signals in target cells is an area of active research, such as high-affinity IgE receptor (FcεRI) internalization, anti-drug IgG4 blocking antibody, altered signaling pathways in mast cells and basophils, and reduced Ca2+ influx. Agents commonly requiring desensitization include antineoplastic agents, antibiotics, antituberculous agents, and aspirin/nonsteroidal antiinflammatory drugs. Various desensitization protocols (rapid or slow, multi-bag or one-bag, with different target doses) have been proposed for each drug. An appropriate protocol should be selected with the appropriate concentration, dosage, dosing interval, and route of administration. In addition, the protocol should be adjusted with consideration of the severity of the initial reaction, the characteristics of the drug itself, as well as the frequency, pattern, and degree of breakthrough reactions.
Topics: Antineoplastic Agents; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Immunoglobulin E; Mast Cells
PubMed: 35123386
DOI: 10.3904/kjim.2021.438 -
Allergy May 2018Drug hypersensitivity reactions (DHRs) represent growing health problem worldwide, affecting more than 7% of the general population, and represent an important public... (Review)
Review
Drug hypersensitivity reactions (DHRs) represent growing health problem worldwide, affecting more than 7% of the general population, and represent an important public health problem. However, knowledge in DHRs morbidity and mortality epidemiological data is still not optimal and international comparable standards remain poorly accessed. Institutional databases worldwide increasingly use the WHO International Classification of Diseases (ICD) system to classify diagnoses, health services utilization, and death data. The misclassification of disorders in the ICD system contributes to a lack of ascertainment and recognition of their importance for healthcare planning and resource allocation. It also hampers clinical practice and prevention actions. To further inform the allergy community and to ensure that the revision process is transparent as advised in the WHO ICD-11 revision agenda, we report the advances and use of the pioneering "Drug hypersensitivity" subsection of ICD-11 and implementation in the WHO International Classification of Health Interventions (ICHI). The new classification addressed to DHRs will enable the collection of more accurate epidemiological data to support quality management of patients with drug allergies and better facilitate healthcare planning and decision-making and public health measures to prevent and reduce the morbidity and mortality attributable to DHRs.
Topics: Drug Hypersensitivity; Humans; International Classification of Diseases; World Health Organization
PubMed: 29105793
DOI: 10.1111/all.13335 -
CMAJ : Canadian Medical Association... Apr 2019
Topics: Allergens; Drug Hypersensitivity; Egg Proteins; Humans; Immunoglobulin E; Intradermal Tests; Practice Guidelines as Topic; Vaccines
PubMed: 30962198
DOI: 10.1503/cmaj.190208 -
Self-reported drug allergy in health care workers in conservative and surgical medicine departments.Journal of Investigational Allergology... 2012Drug allergy comprises 10% to 30% of all adverse drug reactions, and according to data from the literature, sensitivity to drug allergens is 2 to 3 times more common in...
BACKGROUND
Drug allergy comprises 10% to 30% of all adverse drug reactions, and according to data from the literature, sensitivity to drug allergens is 2 to 3 times more common in health care workers than in the general population.
OBJECTIVE
The aims of this study were to estimate the prevalence of self-reported drug allergy in health care workers and compare the data obtained between doctors and nurses from conservative medicine (CM) and surgical medicine (SM) departments.
METHODS
This was an analytic questionnaire-based survey conducted using the European Network of Drug Allergy questionnaire adapted to the Lithuanian population. The questionnaires were completed by 346 individuals.
RESULTS
Nurses from SM departments reported allergy symptoms more frequently than doctors from the same departments (38.1% vs. 16.7%, P = .01) and nurses from the CM departments (38.1% vs. 18%; P = .02). The most common drugs reported to cause hypersensitivity symptoms were similar in the CM and SM departments: antibiotics (8.8% and 12.7%), local anesthetics (2.9% and 6.9%), and group B vitamins (1.2% and 2.1%). Skin damage was indicated as the most common clinical manifestation.
CONCLUSIONS
Based on the data reported by the questionnaire respondents, drug allergy was most prevalent among nurses from the SM departments, and antibiotics and local anesthetics were the most common substances that induced the symptoms.
Topics: Adult; Drug Hypersensitivity; Female; Health Personnel; Humans; Male; Middle Aged; Nurses; Prevalence; Surgery Department, Hospital; Surveys and Questionnaires
PubMed: 23101311
DOI: No ID Found -
Ugeskrift For Laeger Jul 2020Up to 10% of hospitalised patients are registered as penicillin allergic. However, 80-90% will tolerate penicillin after evaluation. New Danish guidelines suggest... (Review)
Review
Up to 10% of hospitalised patients are registered as penicillin allergic. However, 80-90% will tolerate penicillin after evaluation. New Danish guidelines suggest criteria for evaluation of patients based on risk stratification according to the severity of the index reaction. The allergy label can be removed immediately, if allergy can be ruled out using the criteria presented in this review, but all other patients should be referred for evaluation in a specialist allergy department. Specific IgE measurement should only be done in adult patients with an immediate reaction (onset less-than 2 h after intake of a tablet) or urticaria.
Topics: Adult; Anti-Bacterial Agents; Drug Hypersensitivity; Humans; Penicillins
PubMed: 32734861
DOI: No ID Found -
The Journal of Allergy and Clinical... Aug 2015Immune-mediated (IM) adverse drug reactions (ADRs) are an underrecognized source of preventable morbidity, mortality, and cost. Increasingly, genetic variation in the... (Review)
Review
Immune-mediated (IM) adverse drug reactions (ADRs) are an underrecognized source of preventable morbidity, mortality, and cost. Increasingly, genetic variation in the HLA loci is associated with risk of severe reactions, highlighting the importance of T-cell immune responses in the mechanisms of both B cell-mediated and primary T cell-mediated IM-ADRs. In this review we summarize the role of host genetics, microbes, and drugs in IM-ADR development; expand on the existing models of IM-ADR pathogenesis to address multiple unexplained observations; discuss the implications of this work in clinical practice today; and describe future applications for preclinical drug toxicity screening, drug design, and development.
Topics: Allopurinol; B-Lymphocytes; Carbamazepine; Dideoxynucleosides; Drug Hypersensitivity; Gene Expression Regulation; Genetic Loci; HLA Antigens; Humans; Models, Immunological; Pharmacogenetics; Stevens-Johnson Syndrome; T-Lymphocytes; Virus Diseases
PubMed: 26254049
DOI: 10.1016/j.jaci.2015.05.050