The adverse impact of penicillin allergy labels on antimicrobial stewardship in sepsis and associated pharmacoeconomics: An observational cohort study (IMPALAS study)

Bermingham, William; Hussain, Abid; Bhogal, Rashmeet; Balaji, Ariyur; Krishna, Mamidipudi Thirumala

doi:10.1016/j.jaip.2019.12.030

Cited by 14 publications

(8 citation statements)

References 7 publications

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“…Whilst there is no published evidence regarding the impact of MDAS and MDIS labels (and related conditions) on clinical care and pharmaco‐economics, experience from inaccurate penicillin allergy labels in HICs suggests a significant impact on clinical outcomes, healthcare utilization and healthcare costs. 8 , 49 , 50 , 51 , 52 , 53 Alongside provision of education in basic aspects of drug allergy labelling/de‐labelling, there is a real need to standardize international nomenclature and diagnostic criteria for patients reporting an allergy or intolerance to multiple drugs, as no International Statistical Classification of Diseases codes currently exist. 54 There is scope for further research into MDH/MDHS, in particular to identify risk factors including possible human leucocyte antigen (HLA) 40 associations via a pharmacogenomics approach.…”

Section: Discussionmentioning

confidence: 99%

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Jagpal

Alshareef

Marriott

et al. 2022

Clinical & Translational All

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Background Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco‐economics of MDAS and MDIS. Methods Systematic literature search across 11 databases (01 January 2000–06 November 2020) for MDIS, MDAS and related terminology. Studies were reviewed for quality of evidence and risk of bias by employing Critical Appraisal Skills Programme cohort study checklist. A narrative synthesis approach facilitated by systematic textual descriptions, tabulation and thematic analysis was adopted. Results There was heterogeneity in terminology and methodology. Few studies applied standard drug allergy diagnostic methods. There is some evidence to suggest that multiple drug hypersensitivity syndrome (MDHS; i.e., confirmed allergies in MDAS) is a distinct clinical entity. Prevalence of MDIS and MDAS labels in unselected & selected populations varied between 2.1%–6.4% & 4.9%–90% and 1.2% & 0%–36% respectively. Reported risk factors included female gender, increasing age, body mass index, anxiety, depression, co‐morbidities, concurrent allergies and increased healthcare utilization. Drugs commonly implicated were antibiotics and non‐steroidal anti‐inflammatory drugs. No studies relating to clinical impact and pharmaco‐economics were found. Conclusion There is considerable burden of MDAS and MDIS labels. Data needs cautious interpretation as majority of studies described involved unverified labels. Despite this limitation and heterogeneity of studies, there is some evidence to suggest that MDHS is a distinct clinical entity. Well‐designed multi‐centre studies applying standardized terminology and diagnostic methodology are needed to gain further insight into these conditions.

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Section: Discussionmentioning

confidence: 99%

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Jagpal

Alshareef

Marriott

et al. 2022

Clinical & Translational All

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“…Experience from penicillin allergy de-labelling has provided great insight into the multifactorial negative impact of allergy labels on patients and healthcare systems and a need for a structured and standardised 'real time' data capture and assessment of ADR episodes. [53][54][55] Application of a standardised e-tool at bedside alongside education of healthcare professionals may facilitate such an approach. 56,57…”

Section: Adr S and H S R S To Anti -Tb Drug Smentioning

confidence: 99%

Practical management of suspected hypersensitivity reactions to anti‐tuberculosis drugs

Bermingham

Bhogal

Nagarajan³

et al. 2022

Clin Experimental Allergy

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Tuberculosis (TB) is the commonest cause of death by a single infectious agent globally and ranks amongst the top ten causes of global mortality. The incidence of TB is highest in Low-Middle Income countries (LMICs). Prompt institution of, and compliance with, therapy are cornerstones for a favourable outcome in TB and to mitigate the risk of multiple drug resistant (MDR)-TB, which is challenging to treat. There is some evidence that adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) to anti-TB drugs occur in over 60% and 3%-4% of patients respectively. Both ADRs and HSRs represent significant barriers to treatment adherence and are recognised risk factors for MDR-TB. HSRs to anti-TB drugs are usually cutaneous and benign, occur within few weeks after commencement of therapy and are likely to be T-cell mediated. Severe and systemic T-cell mediated HSRs and IgE mediated anaphylaxis to anti-TB drugs are relatively rare, but important to recognise and treat promptly. T-cellmediated HSRs are more frequent amongst patients with co-existing HIV infection.

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“…Apart from increased antibiotic costs, this enhances the risk of antimicrobial resistance (AMR) including methicillin resistant Staphylococcus aureus, iatrogenic infections such as Clostridioides difficile and vancomycin resistant Enterococcus, surgical site infections, delayed treatment of sepsis and contributes to longer hospital stay. [6][7][8][9] To put AMR into a global perspective, it results in an estimated 700 000 deaths/year and the burden is higher in low-income countries (LICs; as per World Bank classification; gross national income (GNI) per capita on 1 July 2020, <US$1036) and low-middle-income countries (LMICs; GNI, US$1036-US$4045). 10 11 It has been suggested that if there are no mitigation strategies in place to address AMR by 2050, an estimated loss of 10 million lives alongside a cost of US$100 trillion has been predicted.…”

Section: The Burden and Adverse Impact Of Penicillin Allergy Labels In High-income Countriesmentioning

confidence: 99%

Is spurious penicillin allergy a major public health concern only in high-income countries?

Krishna

Vedanthan

et al. 2021

BMJ Glob Health

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The adverse impact of penicillin allergy labels on antimicrobial stewardship in sepsis and associated pharmacoeconomics: An observational cohort study (IMPALAS study)

Cited by 14 publications

References 7 publications

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Practical management of suspected hypersensitivity reactions to anti‐tuberculosis drugs

Is spurious penicillin allergy a major public health concern only in high-income countries?

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