Allergy entry and deletion in the electronic health record

Blumenthal, Kimberly G.; Acker, Warren W.; Liu, Yu; Holtzman, Niki S.; Zhou, Li

doi:10.1016/j.anai.2016.12.020

Cited by 32 publications

(23 citation statements)

References 9 publications

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“…There are opportunities for dedicated clinical services to manage the documentation of ADR in the hospital setting. Health institutions should implement diagnostic pathways to combat the accumulation of ADR labels over a patient's lifetime …”

Section: Discussionmentioning

confidence: 99%

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Documentation of penicillin adverse drug reactions in electronic health records: inconsistent use of allergy and intolerance labels

Inglis

Caughey

Smith

et al. 2017

Internal Medicine Journal

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The frequency of penicillin allergy label in this data set is consistent with the known overdiagnosis of penicillin allergy in the hospital population. ADR documentation was poor with incomplete entries and inconsistent categorisation. The concepts of allergy and intolerance for ADR classification, whilst mechanistically valid, may not be useful at the point of ADR entry by generalist clinicians. Systematic evaluation of reported ADR is needed to improve the quality of information for future prescribers.

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Section: Discussionmentioning

confidence: 99%

“…Health institutions should implement diagnostic pathways to combat the accumulation of ADR labels over a patient's lifetime. 33…”

Section: Discussionmentioning

confidence: 99%

Documentation of penicillin adverse drug reactions in electronic health records: inconsistent use of allergy and intolerance labels

Inglis

Caughey

Smith

et al. 2017

Internal Medicine Journal

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“…The allergy section of the EHRs we studied is used to not only document true medication allergies, but also to report all manner of adverse effects or intolerances to medications. 33 Incidence of opioid allergy is believed to be very rare, 34 and most patients who report to be allergic to an opioid have instead experienced a side effect that has been misclassified as an allergy. 35 For this reason, side effects and allergic responses were aggregated into a single ‘adverse reactions’ category.…”

Section: Methodsmentioning

confidence: 99%

Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study

et al. 2021

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ObjectivesSex as a biological variable affects response to opioids. However, few reports describe the prevalence of specific adverse reactions to commonly prescribed opioids in men and women separately. A large cohort was used to investigate sex differences in type and occurrence of adverse reactions associated with use of codeine, tramadol, oxycodone and hydrocodone.DesignRetrospective cohort study.SettingParticipants in the Right Drug, Right Dose, Right Time (RIGHT) Study.ParticipantsThe medical records of 8457 participants in the RIGHT Study who received an opioid prescription between 1 January 2004 and 31 December 2017 were reviewed 61% women, 94% white, median age (Q1–Q3)=58 (47–66).Primary and secondary outcome measuresAdverse reactions including gastrointestinal, skin, psychiatric and nervous system issues were collected from the allergy section of each patient’s medical record. Sex differences in the risk of adverse reactions due to prescribed opioids were modelled using logistic regression adjusted for age, body mass index, race and ethnicity.ResultsFrom 8457 participants (of which 449 (5.3%) reported adverse reactions), more women (6.5%) than men (3.4%) reported adverse reactions to at least one opioid (OR (95% CI)=2.3 (1.8 to 2.8), p<0.001). Women were more likely to report adverse reactions to tramadol (OR (95% CI)=2.8 (1.8 to 4.4), p<0.001) and oxycodone (OR (95% CI)=2.2 (1.7 to 2.9), p<0.001). Women were more likely to report gastrointestinal (OR (95% CI)=3.1 (2.3 to 4.3), p<0.001), skin (OR (95% CI)=2.1 (1.4 to 3.3), p=0.001) and nervous system issues (OR (95% CI)=2.3 (1.3 to 4.2), p=0.004).ConclusionsThese findings support the importance of sex as a biological variable to be factored into pain management studies.

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“…In addition, the quality of the allergy entries in the EHR depends on the knowledge of health care providers entering/verifying the information; fortunately, most PEAR allergies are entered by medical doctors. 30 Last, our large health care system in Massachusetts may not be representative of other regions because food allergy has been shown to differ by geographic region-with generally higher estimates in New England 31 and in urban areas. 32 Our covered population includes 2 large tertiary care referral centers that may include more patients with severe allergies than the general population.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of food allergies and intolerances documented in electronic health records

Acker

Plasek

Blumenthal

et al. 2017

Journal of Allergy and Clinical Immunology

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Background: Food allergy prevalence is reported to be increasing, but epidemiological data using patients' electronic health records (EHRs) remain sparse. Objective: We sought to determine the prevalence of food allergy and intolerance documented in the EHR allergy module. Methods: Using allergy data from a large health care organization's EHR between 2000 and 2013, we determined the prevalence of food allergy and intolerance by sex, racial/ethnic group, and allergen group. We examined the prevalence of reactions that were potentially IgE-mediated and anaphylactic. Data were validated using radioallergosorbent test and ImmunoCAP results, when available, for patients with reported peanut allergy. Results: Among 2.7 million patients, we identified 97,482 patients (3.6%) with 1 or more food allergies or intolerances (mean, 1.4 6 0.1). The prevalence of food allergy and intolerance was higher in females (4.2% vs 2.9%; P < .001) and Asians (4.3% vs 3.6%; P < .001). The most common food allergen groups were shellfish (0.9%), fruit or vegetable (0.7%), dairy (0.5%), and peanut (0.5%). Of the 103,659 identified reactions to foods, 48.1% were potentially IgE-mediated (affecting 50.8% of food allergy or intolerance patients) and 15.9% were anaphylactic. About 20% of patients with reported peanut allergy had a radioallergosorbent test/ImmunoCAP performed, of which 57.3% had an IgE level of grade 3 or higher. Conclusions: Our findings are consistent with previously validated methods for studying food allergy, suggesting that the EHR's allergy module has the potential to be used for clinical and epidemiological research. The spectrum of severity observed with

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Allergy entry and deletion in the electronic health record

Cited by 32 publications

References 9 publications

Documentation of penicillin adverse drug reactions in electronic health records: inconsistent use of allergy and intolerance labels

Documentation of penicillin adverse drug reactions in electronic health records: inconsistent use of allergy and intolerance labels

Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study

Prevalence of food allergies and intolerances documented in electronic health records

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