Drug related severe anaphylaxis investigation: A Tunisian retrospective study

Abstract

IntroductionAnaphylactic shock is the most serious manifestation of immediate hypersensitivity reactions. Although this event is rare, its gravity warrants a major interest in identifying the drug in question. AimThe aim of the study was to describe clinical features, etiologic approach and allergological assessment performed in patients referred for exploration of drug-induced severe anaphylaxis. MethodsRetrospective study between January 2000 and July 2021, including patients referred to the allergology consultation of the pneumo-allergology department “C” of the AbderrahmanMami hospital of Ariana in Tunis, for exploration of drug-induced severe anaphylaxis. ResultsTwo hundred ninety patients were referred for exploration of drug hypersensitivitymanifestations, 54 patients presented with suspected drug-induced severe anaphylaxis. The average age was 33.52 years [6–72 years]. Twenty patients were male and 34 were female (sex ratio=0.6). Twelve patients had a family history of drug allergy. The average time to onset of signs of anaphylaxis compared to the start of treatment was 9.52 days [1–26 days], the average time to onset of signs of anaphylaxis compared to the last drug intake was 49minutes [10-240minutes]. After excluding 2 patients in whom the allergological assessment was carried out after 20 years, the average time taken to perform the allergological assessment was 8.59 months. The drugs incriminated were: beta-lactams (n=29), anti-tuberculosis drugs (n=9), non-steroidal anti-inflammatory drugs (n=4), general anesthetics (n=6) and acetaminophen (n=6). The subsequent course of action was to eliminate the offending drug in 45 patients, and ultra-rapid desensitization to anti-tuberculosis drugs in 9 patients. ConclusionDrug-induced severe anaphylaxis is not rare. The identification of the offending drug makes it possible to avoid it and to offer alternatives to this treatment.