Abstract
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.
Highlights
A drug hypersensitivity reaction (DHR) can be defined as an adverse drug reaction (ADR), with an immunological etiology, to an otherwise safe and effective therapeutic agent (Park and Demoly, 2012; Böhm and Cascorbi, 2016)
DHRs are of significant concern for clinicians and patients as suspected cases may result in avoidance of first-line medications like in cases of suspected β-lactam antibiotic (BL) allergy that leads to worse outcomes and increased cost (Macy and Contreras, 2014; Su et al, 2017; Sousa-Pinto et al, 2018), and in consequence, both under- and overdiagnosis of DHRs are potential challenges in everyday practice
An initial drug allergy evaluation is performed on all patients referred to our clinic for suspected DHRs, and patients presenting with a suggestive history of DHRs from July 2007 to June 2019 were included in this study
Summary
A drug hypersensitivity reaction (DHR) can be defined as an adverse drug reaction (ADR), with an immunological etiology, to an otherwise safe and effective therapeutic agent (Park and Demoly, 2012; Böhm and Cascorbi, 2016). In vivo and in vitro testing including the gold standard drug provocation test (DPT) can confirm the diagnosis, and clinicians have to challenge problems such as the lack of standardized tests to most of the medications, the contraindication for DPT in severe cases, or patient refusal to undergo a DPT with the culprit drug. These problems push clinicians to accept the diagnosis of drug allergy based on clinical history alone on the cases that there is no standardized test or DPT is not as suitable option. 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
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