11.3% of households report drug hypersensitivities
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Key takeaways:
- Prevalence increased with age, from 3.3% among children aged 10 years and younger to 16.5% among adults aged older than 40 years.
- Prevalence also increased with food allergy, asthma and eczema.
Although 11.3% of households surveyed reported drug hypersensitivities, the prevalence of different hypersensitivities varied significantly, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
However, these findings may overestimate the true prevalence in the general population, Aarthi Kottapalli, BA, research assistant, Center for Food Allergy & Asthma Research (CFAAR), Northwestern University Feinberg School of Medicine, and colleagues wrote.
“Current data indicate that drug hypersensitivities play a role in about 5% to 10% of adverse drug reactions, affecting roughly 15% to 25% of patients,” Kottapalli told Healio. “They’re also responsible for around 35% of all anaphylaxis cases in the United States and can lead to fatal reactions.”
Yet remarkably little is known regarding the prevalence and distribution of drug hypersensitivities in the general population, Kottapalli said, since routine population-level disease surveillance does not include these conditions.
“We at CFAAR had conducted a large nationally representative survey aiming to estimate the distribution and determinants of food allergies a few years prior that collected some relevant data on patient and patient-reported drug allergies, so we decided to leverage these to shed some much-needed light on this important topic,” Kottapalli said.
Study design, results
The researchers conducted a cross-sectional survey in both Spanish and English of a nationally representative sample of 51,819 households, including data for 38,408 children and 40,443 adults, between 2015 and 2016.
The survey found that 3.3% (95% CI, 2.8%-3.3%) of children aged 10 years and younger had a physician-diagnosed drug hypersensitivity. This increased to 5.3% (95% CI, 4.5%-6.2%) for adolescents aged 11 to 17 years.
Rates continued to increase with age, with 8.4% (95% CI, 7.8%-9%) for adults aged 18 to 39 years and 16.5% (95% CI, 15.9%-17.2%) for those aged 40 years and older.
Odds for a history of drug hypersensitivity increased also with female sex compared with male sex (15.02% vs. 7.49%; P < .0001) and with identification as non-Hispanic white race and ethnicity, education, and residency in the Northeastern census division as well.
Further, odds for a history of drug hypersensitivity increased with IgE-mediated food allergies (20.8%; 95% CI, 17.9%-21.3%), asthma (19.3%; 95% CI, 18%-20.7%), atopic dermatitis/eczema (17.7%; 95% CI, 16%-19.5%), allergic rhinitis (24.2%; 95% CI, 23.1%-25.4%) and urticaria/chronic hives (41.3%; 95% CI, 35.7%-47.2%).
Generally, these percentages increased with age. For instance, 6.5% (95% CI, 4.6%-9.1%) of children aged 10 years and younger and 29.1% (95% CI, 26.9%-31.3%) of adults aged 40 years and older with asthma also had a drug hypersensitivity.
The survey asked respondents to write in their specific drug hypersensitivities, but not all of them did, the researchers said, indicating that some of these results may be over-representative of their true prevalence.
Many diagnoses occur in childhood without any testing later in life for confirmation, the researchers said, adding that the study’s survey-report design may have impacted findings as well.
As a result, the researchers said that 1.61% (95% CI, 1.48%-1.76%) of the population was impacted by an opioid hypersensitivity, and 6.89% (95% CI, 6.6%-7.19%) reported an antibiotic hypersensitivity.
Similarly, 2.22% (95% CI, 2.06%-2.41%) reported a sulfa-derivative hypersensitivity, 0.66% (95% CI, 0.57%-0.75%) reported a hypersensitivity to one or more NSAIDs, and 0.1% (95% CI, 0.07%-0.15%) reported a vaccine hypersensitivity.
These rates of hypersensitivity for each drug investigated increased with age as well. For example, 0.06% (95% CI, 0.03%-0.13%) of children aged 10 years and younger and 2.82% (95% CI, 2.57%-3.1%) of adults aged 40 years and older had an opioid hypersensitivity.
Conclusions, next steps
“The data indicate that over one in 10 Americans report at least one physician-diagnosed drug allergy, the most common of which is antibiotic allergy,” Kottapalli said.
This burden appears to vary across different demographic groups and is more significant among individuals who report IgE-mediated allergies, such as food allergies and allergic rhinitis, or have received a diagnosis of urticaria/chronic hives from a physician.
“One reason this is important is because patients with suspected allergy to first-line antibiotics, whether or not it is or was ever truly present in the patient, are often given less effective and broader spectrum antibiotics that can also contribute to antimicrobial resistance,” Kottapalli said.
Also, Kottapalli said, these estimates offer a crucial reference point for understanding how common hypersensitivity is to various commonly used medications for pain management and bacterial infections.
This information additionally empowers physicians to potentially tailor treatment plans more effectively by considering patients’ specific medical histories and demographic backgrounds, she continued.
“Crucially, the fact that so many patients report a history of drug hypersensitivity highlights the importance of advancing efforts to test and de-label patients when appropriate so that we can avoid unnecessary use of alternative agents that may not only lead to worse patient outcomes, but also contribute to the growing scourge of drug resistance,” Kottapalli said.
Kottapalli and her colleagues also hope these results help both the general population and allergists and immunologists to recognize the importance of not only testing for drug allergies, but also retesting individuals with documented drug allergies in hopes of de-labeling the ones that patients might outgrow.
“Ensuring accurate drug allergy labels is crucial in enhancing patient care by preventing medication errors and adverse reactions, ultimately resulting in improved hospital outcomes, fewer complications, and enhanced patient safety and care,” Kottapalli said.
The researchers called for additional research to determine the factors that contribute to these demographic disparities in hypersensitivities so physicians can better understand and treat them in conjunction with other comorbidities.
Specifically, the researchers recommended more studies of the associations between IgE-mediated allergies, chronic urticaria and other atopic disease and drug hypersensitivities to see which correlations can be attributed to shared IgE-driven mechanisms or to other factors.
“Given that the present estimates are based on data collected in 2016, and almost certainly comprise an overestimate of the true U.S. population-level prevalence of drug hypersensitivity at that time, further epidemiologic studies employing more rigorous, clinical confirmation of reported cases are clearly needed to arrive at more accurate prevalence estimates of the current burden of drug hypersensitivity,” Kottapalli said.
For more information:
Aarthi Kottapalli, BA, can be reached at aarthikottapalli2023@u.northwestern.edu.
Perspective
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These findings are not surprising. The main issue with the study is that it relies on patient reports of physician-diagnosed drug allergy, and we know that patients over-report and that physicians over-diagnose drug allergy.
Drug allergy does tend to present most commonly in women. Also, patients with urticaria often have more drug allergy labels due to urticaria being misattributed to drugs.
The best thing that doctors can recognize is that drug allergy is over-diagnosed and that it is important to have an allergy/immunology specialist weigh in when a drug is needed. Surveys surrounding drug allergy de-labeling would be more helpful as well.
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