Skip to main content
Erschienen in: Wiener klinische Wochenschrift 13-14/2019

29.04.2019 | original article

Incidence, etiology, predictors and outcomes of suspected drug hypersensitivity reactions in a tertiary care university hospital’s emergency department

A retrospective study

verfasst von: Cvijeta Bielen, Luka Bielen, Robert Likić, MD, PhD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 13-14/2019

Einloggen, um Zugang zu erhalten

Summary

Background

Allergic drug reactions are adverse drug reactions that result from a specific immunologic response to a medication. Considering the epidemiological and clinical importance of drug allergy, this retrospective analysis focused on drug hypersensitivity in a tertiary care university hospital emergency department (ED).

Methods

In this study 74,929 ED records obtained from March 2012 to March 2015 were reviewed to determine the incidence, etiology, predictors and clinical features of drug hypersensitivity.

Results

The observed incidence of drug hypersensitivity was 0.87% of all ED admissions. It was significantly higher in female patients aged 18–29 years (2.26%; P < 0.0001) and during winter months (1.09%; P = 0.0058). Most patients had mild to moderate symptoms which regressed following ED treatment. Only five patients (7 per 100,000 ED visits) were diagnosed with drug-induced anaphylaxis, and only five patients were provisionally diagnosed with severe non-immediate reactions with systemic involvement. No patient died of drug hypersensitivity in the ED, and only a small proportion required subsequent hospitalization. The most common causes of drug hypersensitivity reactions were amoxicillin and paracetamol.

Conclusion

Drug hypersensitivity is a common reason for tertiary centre emergency admissions. This is the largest analysis of ED drug hypersensitivity admissions so far. Beta-lactams were identified as the leading cause of drug hypersensitivity requiring ED evaluation, which also explains the peak of drug hypersensitivity cases during winter months when the use of these medications is highest.
Anhänge
Nur mit Berechtigung zugänglich
Fußnoten
1
MedDRA version 20.0 was used. The aim of this SMQ is to retrieve all types of cases possibly related to hypersensitivity reactions. Many terms included in SMQ Hypersensitivity do not permit differentiation between hypersensitivity reactions and other causes for the given event and therefore further analysis of cases retrieved by the SMQ is required.
 
Literatur
1.
Zurück zum Zitat Stone SF, Phillips EJ, Wiese MD, Heddle RJ, Brown SGA. Immediate-type hypersensitivity drug reactions. Br J Clin Pharmacol. 2014;78(1):1–13.CrossRef Stone SF, Phillips EJ, Wiese MD, Heddle RJ, Brown SGA. Immediate-type hypersensitivity drug reactions. Br J Clin Pharmacol. 2014;78(1):1–13.CrossRef
2.
Zurück zum Zitat Moore N, Briffaut C, Noblet C, Normand CA, Thuillez C. Indirect drug-related costs. Lancet. 1995;345(8949):588–9.CrossRef Moore N, Briffaut C, Noblet C, Normand CA, Thuillez C. Indirect drug-related costs. Lancet. 1995;345(8949):588–9.CrossRef
3.
Zurück zum Zitat Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. JAMA. 1998;279(15):1200–5.CrossRef Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. JAMA. 1998;279(15):1200–5.CrossRef
4.
Zurück zum Zitat Hohl CM, Nosyk B, Kuramoto L, Zed PJ, Brubacher JR, Abu-Laban RB, et al. Outcomes of emergency department patients presenting with adverse drug events. Ann Emerg Med. 2011;58(3):270–279.e4.CrossRef Hohl CM, Nosyk B, Kuramoto L, Zed PJ, Brubacher JR, Abu-Laban RB, et al. Outcomes of emergency department patients presenting with adverse drug events. Ann Emerg Med. 2011;58(3):270–279.e4.CrossRef
5.
Zurück zum Zitat Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12.CrossRef Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12.CrossRef
6.
Zurück zum Zitat Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992–2012. J Allergy Clin Immunol. 2015;135(4):956–963.e1.CrossRef Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, Garcez T, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992–2012. J Allergy Clin Immunol. 2015;135(4):956–963.e1.CrossRef
10.
Zurück zum Zitat Mirakian R, Ewan PW, Durham SR, Youlten LJF, Dugué P, Friedmann PS, et al. BSACI guidelines for the management of drug allergy. Clin Exp. Allergy. 2009;39(1):43–61. Mirakian R, Ewan PW, Durham SR, Youlten LJF, Dugué P, Friedmann PS, et al. BSACI guidelines for the management of drug allergy. Clin Exp. Allergy. 2009;39(1):43–61.
11.
Zurück zum Zitat Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026–45.CrossRef Muraro A, Roberts G, Worm M, Bilò MB, Brockow K, Fernández Rivas M, et al. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026–45.CrossRef
12.
Zurück zum Zitat Dworzynski K, Ardern-Jones M, Nasser S. Diagnosis and management of drug allergy in adults, children and young people: Summary of NICE guidance. BMJ. 2014;349:g4852.CrossRef Dworzynski K, Ardern-Jones M, Nasser S. Diagnosis and management of drug allergy in adults, children and young people: Summary of NICE guidance. BMJ. 2014;349:g4852.CrossRef
13.
Zurück zum Zitat Moellman JJ, Bernstein JA, Lindsell C, Banerji A, Busse PJ, Camargo CA, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014;21(4):469–84.CrossRef Moellman JJ, Bernstein JA, Lindsell C, Banerji A, Busse PJ, Camargo CA, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014;21(4):469–84.CrossRef
14.
Zurück zum Zitat Hitti EA, Zaitoun F, Harmouche E, Saliba M, Mufarrij A. Acute allergic reactions in the emergency department: Characteristics and management practices. Eur J Emerg Med. 2015;22(4):253–9.CrossRef Hitti EA, Zaitoun F, Harmouche E, Saliba M, Mufarrij A. Acute allergic reactions in the emergency department: Characteristics and management practices. Eur J Emerg Med. 2015;22(4):253–9.CrossRef
15.
Zurück zum Zitat Moro Moro M, Tejedor Alonso MA, Esteban Hernández J, Múgica García MV, Rosado Ingelmo A, Vila Albelda C. Incidence of anaphylaxis and subtypes of anaphylaxis in a general hospital emergency department. J Investig Allergol Clin Immunol. 2011;21(2):142–9.PubMed Moro Moro M, Tejedor Alonso MA, Esteban Hernández J, Múgica García MV, Rosado Ingelmo A, Vila Albelda C. Incidence of anaphylaxis and subtypes of anaphylaxis in a general hospital emergency department. J Investig Allergol Clin Immunol. 2011;21(2):142–9.PubMed
16.
Zurück zum Zitat Piromrat K, Chinratanapisit S, Trathong S. Anaphylaxis in an emergency department: A 2-year study in a tertiary-care hospital. Asian Pac J Allergy Immunol. 2008;26(2/3):121–8.PubMed Piromrat K, Chinratanapisit S, Trathong S. Anaphylaxis in an emergency department: A 2-year study in a tertiary-care hospital. Asian Pac J Allergy Immunol. 2008;26(2/3):121–8.PubMed
17.
Zurück zum Zitat Dhopeshwarkar N, Sheikh A, Doan R, Topaz M, Bates DW, Blumenthal KG, et al. Drug-induced anaphylaxis documented in electronic health records. J Allergy Clin Immunol Pract. 2019;7(1):103–11.CrossRef Dhopeshwarkar N, Sheikh A, Doan R, Topaz M, Bates DW, Blumenthal KG, et al. Drug-induced anaphylaxis documented in electronic health records. J Allergy Clin Immunol Pract. 2019;7(1):103–11.CrossRef
18.
Zurück zum Zitat Wöhrl S. NSAID hypersensitivity—Recommendations for diagnostic work up and patient management. Allergo J Int. 2018;27(4):114–21.CrossRef Wöhrl S. NSAID hypersensitivity—Recommendations for diagnostic work up and patient management. Allergo J Int. 2018;27(4):114–21.CrossRef
19.
Zurück zum Zitat Mawhirt SL, Fonacier LS, Calixte R, Davis-Lorton M, Aquino MR. Skin testing and drug challenge outcomes in antibiotic-allergic patients with immediate-type hypersensitivity. Ann Allergy Asthma Immunol. 2017;118(1):73–9.CrossRef Mawhirt SL, Fonacier LS, Calixte R, Davis-Lorton M, Aquino MR. Skin testing and drug challenge outcomes in antibiotic-allergic patients with immediate-type hypersensitivity. Ann Allergy Asthma Immunol. 2017;118(1):73–9.CrossRef
20.
Zurück zum Zitat Albin S, Agarwal S. Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population. Allergy Asthma Proc. 2014;35(6):489–94.CrossRef Albin S, Agarwal S. Prevalence and characteristics of reported penicillin allergy in an urban outpatient adult population. Allergy Asthma Proc. 2014;35(6):489–94.CrossRef
21.
Zurück zum Zitat Birmingham LE, Cochran T, Frey JA, Stiffler KA, Wilber ST. Emergency department use and barriers to wellness: A survey of emergency department frequent users. BMC Emerg Med. 2016;17(1):16.CrossRef Birmingham LE, Cochran T, Frey JA, Stiffler KA, Wilber ST. Emergency department use and barriers to wellness: A survey of emergency department frequent users. BMC Emerg Med. 2016;17(1):16.CrossRef
22.
Zurück zum Zitat Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol. 2005;5(4):309–16.CrossRef Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol. 2005;5(4):309–16.CrossRef
23.
Zurück zum Zitat Gomes E, Cardoso MF, Praça F, Gomes L, Mariño E, Demoly P. Self-reported drug allergy in a general adult Portuguese population. Clin Exp Allergy. 2004;34(10):1597–601.CrossRef Gomes E, Cardoso MF, Praça F, Gomes L, Mariño E, Demoly P. Self-reported drug allergy in a general adult Portuguese population. Clin Exp Allergy. 2004;34(10):1597–601.CrossRef
24.
Zurück zum Zitat Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, et al. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy. 2015;45(2):300–27.CrossRef Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, et al. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy. 2015;45(2):300–27.CrossRef
25.
Zurück zum Zitat Castells Guitart MC. Rapid drug desensitization for hypersensitivity reactions to chemotherapy and monoclonal antibodies in the 21st century. J Investig Allergol Clin Immunol. 2014;24(2):72–9.PubMed Castells Guitart MC. Rapid drug desensitization for hypersensitivity reactions to chemotherapy and monoclonal antibodies in the 21st century. J Investig Allergol Clin Immunol. 2014;24(2):72–9.PubMed
26.
Zurück zum Zitat Hsu Blatman KS, Hepner DL. Current knowledge and management of hypersensitivity to perioperative drugs and radiocontrast media. J Allergy Clin Immunol Pract. 2017;5(3):587–92.CrossRef Hsu Blatman KS, Hepner DL. Current knowledge and management of hypersensitivity to perioperative drugs and radiocontrast media. J Allergy Clin Immunol Pract. 2017;5(3):587–92.CrossRef
27.
Zurück zum Zitat Pfützner W, Brockow K. Perioperative drug reactions—Practical recommendations for allergy testing and patient management. Allergo J Int. 2018;27(4):126–9.CrossRef Pfützner W, Brockow K. Perioperative drug reactions—Practical recommendations for allergy testing and patient management. Allergo J Int. 2018;27(4):126–9.CrossRef
28.
Zurück zum Zitat Rubegni P, Cevenini G, Lamberti A, Bruni F, Tiezzi R, Verzuri A, et al. Dermatological conditions presenting at the Emergency Department in Siena University Hospital from 2006 to 2011. J Eur Acad Dermatol Venereol. 2015;29(1):164–8.CrossRef Rubegni P, Cevenini G, Lamberti A, Bruni F, Tiezzi R, Verzuri A, et al. Dermatological conditions presenting at the Emergency Department in Siena University Hospital from 2006 to 2011. J Eur Acad Dermatol Venereol. 2015;29(1):164–8.CrossRef
30.
Zurück zum Zitat Johansson SGO, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832–6.CrossRef Johansson SGO, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832–6.CrossRef
Metadaten
Titel
Incidence, etiology, predictors and outcomes of suspected drug hypersensitivity reactions in a tertiary care university hospital’s emergency department
A retrospective study
verfasst von
Cvijeta Bielen
Luka Bielen
Robert Likić, MD, PhD
Publikationsdatum
29.04.2019
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 13-14/2019
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-019-1499-0

Weitere Artikel der Ausgabe 13-14/2019

Wiener klinische Wochenschrift 13-14/2019 Zur Ausgabe

MUW researcher of the month

MUW researcher of the month

mitteilungen der gesellschaft der ärzte in wien

Veranstaltungstipps