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What concerns the drug allergy patient?

Published online: August 23, 2020

Assessments for drug allergy have been expanding in the United States (US); however, little is known about the patients who seek or are referred for drug allergy evaluations or their concerns.  Expanding the number and scope of drug allergy assessments in the US is impeded by multiple factors, including provider and healthcare system factors, but patient concerns may also impact the uptake, dissemination, and/or clinical effectiveness of drug allergy evaluations.

In this study published in The Journal of Allergy and Clinical Immunology: In Practice, Blumenthal et al. analyzed data from a newly established multi-site prospective cohort study of patients evaluated for drug allergy, the United States Drug Allergy Registry (USDAR; see usdar.massgeneral.org).  Data from 3 initial USDAR sites (Massachusetts General Hospital [Boston, MA], Vanderbilt University Medical Center [Nashville, TN], and Rochester Regional Health [Rochester, NY]) were included. Investigators determined patient self-reported characteristics from survey instruments and qualitatively coded free-text patient concerns about their drug allergy/allergies. Patient concerns were identified from the free-text response to the question, “What is your biggest concern about your drug allergy/allergies?” The authors also assessed associations between patient characteristics and drug allergy concerns using multinomial logistic regression models.

The coding frame of the qualitative analysis identified 6 mutually exclusive descriptions to fit the patients’ primary concerns: optimal medication use, allergic reaction, diagnosis, severe allergic reaction, no concerns, and other. Optimal medication use included concerns about not being able to use a specific drug or drug class that was indicated for a particular condition. Examples of optimal medication use included penicillin antibiotic use for group B Streptococcus infection or a chemotherapeutic agent for cancer treatment. Allergic reaction included concerns about allergic reactions that impacted patient comfort or quality of life but did not include concerns about significant patient harm or death. Examples of allergic reaction included itching and rashes. Diagnosis included concerns about knowing if a diagnosed allergy was true or finding a cause for a specific symptom experienced (e.g., hives). Severe allergic reaction included patients’ concerns about anaphylaxis, substantial bodily harm, and/or death. The Other category included concerns that did not fit within the coding frame such as concerns about pain, general health, or pregnancy.

Of 592 included patients (age 49 [Standard Deviation 17] years, 74% Female, 88% white), the most commonly reported drug allergies were penicillins (78%), cephalosporins (12%) and sulfonamides (12%) with common reactions of rash (62%), hives (54%), itching (48%), flushing or facial redness (28%), and swelling or angioedema (24%). Patient concerns, coded from free-text, were optimal medication use (41%), no concern (17%), allergic reaction (14%), diagnosis (12%), and severe allergic reaction (12%).  Using multinomial regression, the presence of drug allergy concerns increased with greater age, higher number of reported drug reactions, more antibiotic use, and certain reaction symptoms, most notably mouth or palate itching. Female sex was associated with increased severe allergic reaction concern. Poorer general and mental health was associated with increased allergic reaction concern.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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