Changing patterns in the epidemiology of drug allergy

Abstract

Drug allergy (DA) remains a complex and unaddressed problem worldwide that often deprives patients of optimal medication choices and places them at risk for life‐threatening reactions. Underdiagnosis and overdiagnosis are common and due to the lack of standardized definitions and biomarkers. The true burden of DA is unknown, and recent efforts in data gathering through electronic medical records are starting to provide emerging patterns around the world. Ten percent of the general population engaged in health care claim to have a DA, and the most common label is penicillin allergy. Up to 20% of emergency room visits for anaphylaxis are due to DA and 15%–20% of hospitalized patients report DA. It is estimated that DA will increase based on the availability and use of new and targeted antibiotics, vaccines, chemotherapies, biologicals, and small molecules, which are aimed at improving patient's options and quality of life. Global and regional variations in the prevalence of diseases such as human immunodeficiency virus and mycobacterial diseases, and the drugs used to treat these infections have an impact on DA. The aim of this review is to provide an update on the global impact of DA by presenting emerging data on drug epidemiology in adult and pediatric populations.

Risk factors for drug hypersensitivity reactions in children

“…Chronic diseases enhance the risk of DA due to impaired metabolism at kidney and liver [ 80 ]. Several studies reported that HRs are more common in children with cystic fibrosis (CF); particularly the frequency of BL HRs is higher.…”

“…The same results have been observed by Lalic M et al [ 128 ] who additionally demonstrated that high starting dose AEDs was another risk factor. Moreover, prolonged high dose repeated exposures after treatment suspension, are more likely to lead to HRs than a large single dose since they enhance immune recognition [ 80 , 129 ]. Finally, children are at special risks for HRs since unfriendly dosing formulations of drugs or miscalculation of some health care professional can lead to tenfold overdoses in administration of medicine.…”

“…Topical, intramuscular, and intravenous routes of administration are more likely to cause allergic drug reactions than oral administration. Moreover, parental administration is associated with more severe reactions because of a more rapid absorption and presentation to immune system [ 80 , 129 , 131 ].…”