Prevalence and Impact of Reported Drug Allergies among Rheumatology Patients

Abstract

Background: Drug allergies (DA) are immunologically mediated adverse drug reactions and their manifestations depend on a variety of drug- and patient-specific factors. The dysregulated immune system underpinning rheumatological diseases may also lead to an increase in hypersensitivity reactions, including DA. The higher prevalence of reported DA, especially anti-microbials, also restricts the medication repertoire for these already immunocompromised patients. However, few studies have examined the prevalence and impact of reported DA in this group of patients. Methods: Patients with a diagnosis of rheumatoid arthritis (RA), spondyloarthritis (SpA), or systemic lupus erythematosus (SLE) were recruited from the rheumatology clinics in a tertiary referral hospital between 2018 and 2019. Prevalence and clinical outcomes of reported DA among different rheumatological diseases were calculated and compared to a cohort of hospitalized non-rheumatology patients within the same period. Results: A total of 6081 patients (2541 rheumatology patients: 1286 RA, 759 SpA, and 496 SLE; and 3540 controls) were included. DA was more frequently reported among rheumatology patients compared to controls (23.8% vs. 13.8%, p < 0.01). Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) were the two most commonly reported categories of DA with a prevalence of 12.0% and 5.1%, respectively. Reported antibiotics allergies were more frequent in patients with RA (OR = 1.20, 95% CI = 1.02–1.62, p = 0.03) and SLE (OR = 4.69, 95% CI = 3.69–5.95, p < 0.01); and associated with increased infection-related admissions among rheumatology patients (OR = 1.79, 95% CI = 1.09–2.95, p = 0.02). Among the subgroup of patients referred for allergy testing, 85.7% of beta-lactam antibiotic allergy labels were found to be inaccurate and de-labelled after negative drug provocation testing. Conclusion: The prevalence of reported DA was significantly higher in rheumatology patients. Reported antibiotic allergy was associated with increased rate of infection-related admissions. However, the rate of genuine antibiotic allergy was low. Further studies are needed to guide proper assessment of reported DA and impact of comprehensive allergy testing in this group of patients.

Disproportionate drug allergy labelling among middle-aged patients and barriers to excipient allergy testing from the Hong Kong Comprehensive Excipient and Drug Allergy Registry (CEDAR)

“…29,30 Penicilin allergy labels have also shown to affect geriatric and immunocompromised patients, associated with a multitude of adverse clinical outcomes, including increased healthcare costs, more frequent and longer hospital stays, and even death. 22,[31][32][33] Despite the severe lack of allergists in the Asia-Pacific region, previous multi-disciplinary initiatives have shown much promise in tackling drug allergies. 10,34,35 For example, a nurseled penicillin allergy delabelling initiative demonstrated superior outcomes compared to traditional allergist evaluation in Hong Kong and similar strategies employing trained pharmacists are underway.…”

Characteristics and prevalence of antibiotic allergies in patients with sickle cell disease: A single‐center retrospective study

“…1 Greater rates of reported adverse reactions to antibiotics have been found in patients with an increased risk of bacterial infections (e.g., cystic fibrosis, 2 solid organ and hematopoietic cell transplant recipients 3 ) and in patients who have chronic inflammatory conditions (e.g., systemic lupus erythematous, spondyloarthritis, and rheumatoid arthritis). 4 We hypothesize that SCD, a condition associated with a greater risk of bacterial infections and chronic inflammation, may be associated with increased prevalence of antibiotic allergies. However, there is a literature gap concerning the prevalence and characteristics of antibiotic-associated adverse reactions in patients with SCD.…”

Kleine Ursache – große Wirkung: Spättyp-Hauttests mit Medikamenten als Auslöser von disseminierten Rezidivexanthemen

“…Haarzellleukämie, eigentlich einem niedrig malignen Non-Hodgkin-Lymphom, eine komplexe Situation vor. Patienten mit hämatologischen Grundkrankheiten 6 und Autoimmunkrankheiten 7 scheinen ein etwas höheres Risiko für Exantheme, zumindest auf gewisse Medikamente, aufzuweisen. Das Lymphom wurde zwar nicht aktiv therapiert, wegen einer Panzytopenie lag jedoch eine Immunsuppression vor, weshalb sie gehäuft Infekte erlitt und Verdacht auf eine autoimmune, primär biliäre Zirrhose bestand.…”