Clinical Features of Drug Allergy and Factors Affecting Drug-Related Anaphylaxis: Single-center Experience of the Tertiary University Hospital

Ceyda Tunakan Dalgıç

doi:10.7197/cmj.1342682

EN TR

Clinical Features of Drug Allergy and Factors Affecting Drug-Related Anaphylaxis: Single-center Experience of the Tertiary University Hospital

Abstract

Background-Aims: Drug hypersensitivity is defined as any unfavorable reaction that occurs after the administration of any drug. We aim to determine the frequency, etiology, and clinical features of drug hypersensitivity reactions (DHRs), and to evaluate the factors affecting drug-related anaphylaxis among the patients admitted to the outpatient allergy clinic of the tertiary university hospital. Materials-methods: In this cross-sectional study, medical records of the 8295 patients who visited the allergy outpatient clinic of Sivas Cumhuriyet University Hospital from 2nd July 2018 to 10th December 2019 were retrospectively reviewed by the hospital data system using the ICD-code Y57.4. The frequency, etiologies, demographic and clinical features of the DHRs were evaluated. Results: Among the 8295 patients who visited the allergy outpatient clinic of Sivas Cumhuriyet University Hospital, 159 patients with a mean age of 40,52± 14,85 years (129 female, 30 male) were evaluated with the diagnosis of DHRs. The frequency of DHRs among admissions was found to be approximately 2%. Accompanying allergic diseases included respiratory (17%), cutaneous (10%), venom (n=3), drug (7%), and food hypersensitivity (n=2). Multiple allergic diseases were detected in 20%. Eighty-six % (n=138) could recognize the culprit drug. The causes of drug allergy were non-steroidal anti-inflammatory drugs (NSAIDs) (27%), beta-lactams (16%), co-sensitization to beta-lactams and NSAIDs (8%), antimicrobials except beta-lactams (8%), and other kinds of drugs (39%). Type 1 reaction occurred in 80%, type 4 in 21%, non-immune mediated in 7, and mixed type composed of type 1 and 4 in 9 patients. Anaphylaxis occurred in 46,5%. Fifteen% had grade 2, 22% had grade 3, and 4 had grade 4 anaphylactic reactions. According to systematical assessment, cutaneous symptoms were observed in 93%, respiratory in 38%, cardiovascular in 29,5%, neurologic in 25%, and gastrointestinal in 11%. Allergy to NSAIDs (88,6 %) and beta-lactams (82,5%) were more frequent in type 1 reactions than in type 4 and mixed type reactions (p<0,001). Discussion-conclusions: Drug-related anaphylaxis was commonly grade 3, occurred by NSAIDs and beta-lactams, and presented with cutaneous symptoms. Although drug-induced HSRs generally occurred by NSAII and/or beta-lactams, drugs such as proton pump inhibitors and vitamins were the culprits in up to 40% of the cases. Particular attention should be paid to this group in the evaluation of drug-related anaphylaxis. Healthcare providers and patients need to be informed more in order not to neglect the diagnosis of anaphylaxis and to increase the frequency of adrenaline administration when necessary.

Keywords

İlaç Alerjisinin Klinik Özellikleri ve İlaca Bağlı Anafilaksiyi Etkileyen Faktörler: Üçüncü Basamak Üniversite Hastanesi Tek Merkez Deneyimi

Öz

Giriş- amaç: İlaç aşırı duyarlılığı, herhangi bir ilacın uygulanmasından sonra meydana gelen herhangi bir olumsuz reaksiyon olarak tanımlanır. Amacımız, üçüncü basamak bir üniversite hastanesi alerji polikliniğine başvuran hastalarda ilaç aşırı duyarlılığının sıklığını, etiyolojisini ve klinik özelliklerini belirlemek ve ilaca bağlı anafilaksiyi etkileyen faktörleri değerlendirmektir. Materyal-metodlar: Bu kesitsel çalışmada, Sivas Cumhuriyet Üniversitesi Hastanesi alerji polikliniğine 2 Temmuz 2018 - 10 Aralık 2019 tarihleri arasında başvuran 8295 hastanın tıbbi kayıtları geriye dönük olarak hastane veri sistemi tarafından ICD kodu Y57.4 kullanılarak incelendi. İlaç aşırı duyarlılık reaksiyonlarının (ADR) sıklığı, etiyolojileri, demografik ve klinik özellikleri değerlendirildi. Bulgular: Sivas Cumhuriyet Üniversitesi Hastanesi alerji polikliniğine başvuran 8295 hastadan yaş ortalaması 40,52± 14,85 olan 159 hasta (129 kadın, 30 erkek) ilaca bağlı aşırı duyarlılık reaksiyonu (İAR) tanısı ile değerlendirildi. Başvurular arasında IAR sıklığı yaklaşık %2 saptanmıştır. Eşlik eden alerjik hastalıklar arasında solunum (%17), deri (%10), venom (n=3), ilaç (%7) ve gıda (n=2) aşırı duyarlılığı yer almıştır. Çoklu alerjik hastalık tanısı %20’sinde saptandı. %86'sı (n=138) sorumlu ilacı tanıyabildi. İlaç alerjisinin nedenleri non-steroid anti-inflamatuar ilaçlar (NSAII'ler) (%27), beta-laktam antibiyotikler (%16), beta-laktamlara ve NSAII'lere eş zamanlı duyarlılık varlığı (%8), beta-laktamlar dışındaki antimikrobiyaller (%8) ve diğer tür ilaçlardı (%39). Hastaların %80'inde tip 1, %21'inde tip 4, 7'sinde non-immun aracılı ve 9'unda tip 1 ve 4'ten oluşan mikst tip reaksiyon görüldü. Anafilaksi %46,5 oranında meydana geldi. %15'inde derece 2, %22'sinde derece 3 ve 4'ünde derece 4 anafilaktik reaksiyon vardı. Sistematik değerlendirmeye göre %93 deri, %38 solunum, %29,5 kardiyovasküler, %25 nörolojik ve %11 gastrointestinal semptomlar gözlendi. NSAII'lere (% 88,6) ve beta-laktamlara (% 82,5) alerji, tip 1 reaksiyonlarda, tip 4 ve karma tip reaksiyonlara göre daha sıktı (p<0,001). Tartışma ve sonuçlar: İlaca bağlı anafilaksi genellikle 3. Derece idi, NSAII'ler ve beta-laktamlar tarafından meydana geliyordu ve kutanöz semptomlarla kendini göstermekteydi. İlaca bağlı ADR'ler genellikle NSAII ve/veya beta-laktamlar tarafından meydana gelse de, vakaların %40'e varan kısmında proton pompası inhibitörleri ve vitaminler gibi ilaçlar suçludur. İlaca bağlı anafilaksinin değerlendirilmesinde bu gruba özel dikkat gösterilmelidir. Anafilaksi tanısını ihmal etmemek ve gerektiğinde adrenalin uygulama sıklığını artırmak için sağlık çalışanları ve hastaların daha fazla bilgilendirilmesi gerekmektedir.

Anahtar Kelimeler

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Details

Primary Language

English

Subjects

Health and Community Services

Journal Section

Research Article

Authors

Ceyda Tunakan Dalgıç ^*
0000-0002-0318-3135
Türkiye

Publication Date

September 30, 2023

Submission Date

August 14, 2023

Acceptance Date

September 25, 2023

Published in Issue

Year 2023 Volume: 45 Number: 3

DOI

https://doi.org/10.7197/cmj.1342682

IZ

https://izlik.org/JA99PK66XM

Cite

RIS / Bibtex

AMA

1.Tunakan Dalgıç C. Clinical Features of Drug Allergy and Factors Affecting Drug-Related Anaphylaxis: Single-center Experience of the Tertiary University Hospital. CMJ. 2023;45(3):64-72. doi:10.7197/cmj.1342682