Patients in the United States who present to their physicians for drug allergy assessments have expressed concerns about their potential options for medical treatments, experiencing an allergic reaction, and seeking a diagnosis, according to the results of an analysis published recently in The Journal of Allergy and Clinical Immunology: In Practice.
Recognizing that although drug allergy assessments can improve clinical care, patients’ concerns may affect the optimal diagnostic approach and/or clinical effectiveness of diagnostic testing, investigators sought to evaluate patient apprehensions regarding drug allergies. The current study was conducted in patients who were seen for a drug allergy at the first sites of the United States Drug Allergy Registry (USDAR): Massachusetts General Hospital (MGH) in Boston, Massachusetts; Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee; and Rochester Regional Health (RRH) in Rochester, New York.
Patients’ characteristics and concerns were captured at specialist visits via electronic questionnaires from the Behavioral Risk Factor Surveillance System, National Health Interview Survey, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire. As the allergy information evaluated in this study was derived completely from patient self-reports, the researchers used the term “reported” drug allergy in their findings.
A total of 592 patients were enrolled in the USDAR study. The mean participant age was 49±17 years. The majority of patients were women (74%) and white (88%). Of those enrolled, 70% were from MGH, 18% from VUMC, and 12% from RRH. A total of78% (461 of 592) reported a penicillin allergy and 22% (131 of 592) reported only non-penicillin allergies.
Of the patients evaluated, 38% had only 1 reported drug allergy, 37% had 2 to 3 reported drug allergies, 13% had 4 to 5 reported drug allergies, and 13% had ≥6 drug allergies. Of the non-penicillin allergies, those most often reported included cephalosporins (12%), sulfonamide antibiotics (12%), general/local anesthetics (7%), nonsteroidal anti-inflammatory drugs (3%), and chemotherapeutic agents (2%). The most commonly reported allergic reactions were rash (62%), hives (54%), itching (48%), flushing/facial redness (28%), and swelling/angioedema (24%). Additionally, 8% of participants reported experiencing anaphylaxis.
The most frequently identified concern in patients was optimal medication use, which was reported in 41% of participants. Optimal medication use was more often a concern in patients with a documented penicillin allergy compared with those with only non-penicillin allergies (44% vs 33%, respectively). No concern was reported in 17% of enrolled patients and was significantly more common in those with a reported penicillin allergy than those with only non-penicillin allergies (18% vs 13%, respectively; P =.18).
Allergic reaction was slightly more common in patients with only non-penicillin allergies vs those with a reported penicillin allergy (16% vs 13%, respectively). Other concerns expressed by the participants included diagnosis and severe allergic reaction, both of which were reported in 12% of patients. Severe allergic reaction was a significantly more common concern in patients with only non-penicillin allergies than in those with reported penicillin allergies (22% vs 9%, respectively; P <.001).
Using multinomial regression models, the researchers identified factors associated with patient concerns included older age, higher number of reported drug reactions, experiencing mouth or palate itching, and more antibiotic use.
The investigators concluded that patient concerns can help to inform physician-patient discussions and clinical approaches. Future studies are warranted, in which these concerns are incorporated into structured survey instruments or included in quality-of-life assessments for patients with drug allergy.
Blumenthal KG, Harkness T, Phillips EJ, et al; for the USDAR Study Team. Patient characteristics and concerns about drug allergy: a report from the United States Drug Allergy Registry. J Allergy Clin Immunol Pract. Published online August 24, 2020. doi:10.1016/j.jaip.2020.08.018