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Open AccessArticle

Prevalence and Impact of Reported Drug Allergies among Rheumatology Patients

Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Author to whom correspondence should be addressed.
Diagnostics 2020, 10(11), 918; https://doi.org/10.3390/diagnostics10110918
Received: 28 October 2020 / Revised: 4 November 2020 / Accepted: 7 November 2020 / Published: 9 November 2020
(This article belongs to the Special Issue Diagnosing and Classifying Allergic Diseases: Challenges and Advances)
Background: Drug allergies (DA) are immunologically mediated adverse drug reactions and their manifestations depend on a variety of drug- and patient-specific factors. The dysregulated immune system underpinning rheumatological diseases may also lead to an increase in hypersensitivity reactions, including DA. The higher prevalence of reported DA, especially anti-microbials, also restricts the medication repertoire for these already immunocompromised patients. However, few studies have examined the prevalence and impact of reported DA in this group of patients. Methods: Patients with a diagnosis of rheumatoid arthritis (RA), spondyloarthritis (SpA), or systemic lupus erythematosus (SLE) were recruited from the rheumatology clinics in a tertiary referral hospital between 2018 and 2019. Prevalence and clinical outcomes of reported DA among different rheumatological diseases were calculated and compared to a cohort of hospitalized non-rheumatology patients within the same period. Results: A total of 6081 patients (2541 rheumatology patients: 1286 RA, 759 SpA, and 496 SLE; and 3540 controls) were included. DA was more frequently reported among rheumatology patients compared to controls (23.8% vs. 13.8%, p < 0.01). Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) were the two most commonly reported categories of DA with a prevalence of 12.0% and 5.1%, respectively. Reported antibiotics allergies were more frequent in patients with RA (OR = 1.20, 95% CI = 1.02–1.62, p = 0.03) and SLE (OR = 4.69, 95% CI = 3.69–5.95, p < 0.01); and associated with increased infection-related admissions among rheumatology patients (OR = 1.79, 95% CI = 1.09–2.95, p = 0.02). Among the subgroup of patients referred for allergy testing, 85.7% of beta-lactam antibiotic allergy labels were found to be inaccurate and de-labelled after negative drug provocation testing. Conclusion: The prevalence of reported DA was significantly higher in rheumatology patients. Reported antibiotic allergy was associated with increased rate of infection-related admissions. However, the rate of genuine antibiotic allergy was low. Further studies are needed to guide proper assessment of reported DA and impact of comprehensive allergy testing in this group of patients. View Full-Text
Keywords: allergy; drug; hypersensitivity; prevalence; rheumatology allergy; drug; hypersensitivity; prevalence; rheumatology
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MDPI and ACS Style

Chan, S.C.W.; Yeung, W.W.Y.; Wong, J.C.Y.; Chui, E.S.H.; Lee, M.S.H.; Chung, H.Y.; Cheung, T.T.; Lau, C.S.; Li, P.H. Prevalence and Impact of Reported Drug Allergies among Rheumatology Patients. Diagnostics 2020, 10, 918. https://doi.org/10.3390/diagnostics10110918

AMA Style

Chan SCW, Yeung WWY, Wong JCY, Chui ESH, Lee MSH, Chung HY, Cheung TT, Lau CS, Li PH. Prevalence and Impact of Reported Drug Allergies among Rheumatology Patients. Diagnostics. 2020; 10(11):918. https://doi.org/10.3390/diagnostics10110918

Chicago/Turabian Style

Chan, Shirley C.W.; Yeung, Winnie W.Y.; Wong, Jane C.Y.; Chui, Ernest S.H.; Lee, Matthew S.H.; Chung, Ho Y.; Cheung, Tommy T.; Lau, Chak S.; Li, Philip H. 2020. "Prevalence and Impact of Reported Drug Allergies among Rheumatology Patients" Diagnostics 10, no. 11: 918. https://doi.org/10.3390/diagnostics10110918

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