Anaesthetist's responses to patients' self-reported drug allergies

Abstract

The majority of the self-reported allergies were in fact simply accepted adverse effects of the drugs concerned. The patients' reported drug 'allergy' history was generally well respected by anaesthetists and other medical staff. There were 13 incidents, mainly involving morphine, where patients were given a drug to which they had claimed a specific allergy. There were 101 incidents in 89 patients where drugs of the same pharmacological group as that of their allergic drug were used. There were no untoward reactions in 84 patients who had claimed a prior adverse reaction to penicillin who were given cephalosporins. There were no sequelae from any other events. While anaesthetists generally respected patients self-reported 'allergies', more attention needs to be paid to the accurate recording of patients' events and a clear distinction should be made both in medical records and to the patient between true drug allergy and simple adverse drug reactions.

An audit of preoperative evaluation of general surgery patients at Dr George Mukhari Hospital

“…12 Details of the previous adverse drug events, including allergies, must be recorded. Making such an assessment will assist in correct decision making.…”

Drug Allergy in Hospitalized Patients: The Contribution of Allergy Consultation and a Structured Questionnaire

“…The current results support data previously reported by Lutomski et al [3] that showed significant discrepancies between medical records and in-depth allergy history taking. A similar study by MacPherson et al [5] clearly demonstrated that the patients’ self-reported drug allergies are unreliable and when taken as a fact they cause medical treatment to deviate from standard of care. Taken together, the data collected from the first part of the current study strongly suggest the need for better allergy history taking in order to eliminate overdiagnosis of drug allergy and distinguish between allergy, anticipated side effects and other nonrelated reactions.…”

“…Discrepancies between the medical records and meticulous allergy histories were common and the validity of reported allergic reactions was questionable. Incomplete documentation of the drug allergy status of a patient appears to be related mainly to deficient history taking and failure to distinguish between a clinical presentation suggestive of drug allergy and a simple adverse drug reaction, mostly related to the physician’s education rather than the patient’s ability to provide the information [4,5]. Various interventions have been suggested in an effort to improve the diagnosis of adverse drug reactions with suspected drug allergy (ADRSA).…”

“…Various interventions have been suggested in an effort to improve the diagnosis of adverse drug reactions with suspected drug allergy (ADRSA). These include history taking by pharmacists [6,7,8] as well as means of better documentation [3,5]. …”

A UK hospital survey to explore healthcare professional views and attitudes to patients incorrectly labelled as penicillin allergic: an antibiotic stewardship patient safety project

“…An added complication is that a patient's recollection of their allergy often does not tally with their medical records. 10,11 Spurious or incorrect penicillin allergy records can arise for several reasons: often, side effects from a previous course of treatment end up recorded as an "allergy" in a patient's record. The prevalence of penicillin allergy records that were attributable to nonallergic side effects has been reported to be between 16-50%, 12,13 with many of these patients able to safely tolerate the first line penicillin antibiotics after appropriate investigation.…”