Drug-Induced Anaphylaxis Documented in Electronic Health Records

Abstract

Background: Although drugs represent a common cause of anaphylaxis, few large studies of drug-induced anaphylaxis have been performed.

Objective: To describe the epidemiology and validity of reported drug-induced anaphylaxis in the electronic health records (EHRs) of a large United States health care system.

Methods: Using EHR drug allergy data from 1995 to 2013, we determined the population prevalence of anaphylaxis including anaphylaxis prevalence over time, and the most commonly implicated drugs/drug classes reported to cause anaphylaxis. Patient risk factors for drug-induced anaphylaxis were assessed using a logistic regression model. Serum tryptase and allergist visits were used to assess the validity and follow-up of EHR-reported anaphylaxis.

Results: Among 1,756,481 patients, 19,836 (1.1%) reported drug-induced anaphylaxis; penicillins (45.9 per 10,000), sulfonamide antibiotics (15.1 per 10,000), and nonsteroidal anti-inflammatory drugs (NSAIDs) (13.0 per 10,000) were most commonly implicated. Patients with white race (odds ratio [OR] 2.38, 95% CI 2.27-2.49), female sex (OR 2.20, 95% CI 2.13-2.28), systemic mastocytosis (OR 4.60, 95% CI 2.66-7.94), Sjögren's syndrome (OR 1.94, 95% CI 1.47-2.56), and asthma (OR 1.50, 95% CI 1.43-1.59) had an increased odds of drug-induced anaphylaxis. Serum tryptase was performed in 135 (<1%) anaphylaxis cases and 1,587 patients (8.0%) saw an allergist for follow-up.

Conclusions: EHR-reported anaphylaxis occurred in approximately 1% of patients, most commonly from penicillins, sulfonamide antibiotics, and NSAIDs. Females, whites, and patients with mastocytosis, Sjögren's syndrome, and asthma had increased odds of reporting drug-induced anaphylaxis. The low observed frequency of tryptase testing and specialist evaluation emphasize the importance of educating providers on anaphylaxis management.

Keywords: Allergy; Drug; Electronic health records; Epidemiology; Hypersensitivity; IgE.

Figure 1

Drug anaphylaxis over time. (A) Number of patients with reported drug-induced anaphylaxis and total number of patients in Partners’ Enterprise-wide Allergy Repository (PEAR) each year for the study period. (B) Incidence rate of drug-induced anaphylaxis during the study period. (C–E) Drug-induced anaphylaxis reports for each drug class out of total drug-induced anaphylaxis reports each year during the study period. (C) Antibiotic anaphylaxis. (D) Analgesic or anesthetic anaphylaxis. (E) Other drug-associated anaphylaxis.

Figure 1

Drug anaphylaxis over time. (A) Number of patients with reported drug-induced anaphylaxis and total number of patients in Partners’ Enterprise-wide Allergy Repository (PEAR) each year for the study period. (B) Incidence rate of drug-induced anaphylaxis during the study period. (C–E) Drug-induced anaphylaxis reports for each drug class out of total drug-induced anaphylaxis reports each year during the study period. (C) Antibiotic anaphylaxis. (D) Analgesic or anesthetic anaphylaxis. (E) Other drug-associated anaphylaxis.

Figure 1

Drug anaphylaxis over time. (A) Number of patients with reported drug-induced anaphylaxis and total number of patients in Partners’ Enterprise-wide Allergy Repository (PEAR) each year for the study period. (B) Incidence rate of drug-induced anaphylaxis during the study period. (C–E) Drug-induced anaphylaxis reports for each drug class out of total drug-induced anaphylaxis reports each year during the study period. (C) Antibiotic anaphylaxis. (D) Analgesic or anesthetic anaphylaxis. (E) Other drug-associated anaphylaxis.

Figure 2

Tryptase testing in drug-induced anaphylaxis cases from 2009 until 2013. Of 17,242 cases of drug-induced anaphylaxis, 135 had a tryptase test within 1 week of anaphylaxis recorded date.

Figure 3

Tryptase testing and allergy/immunology specialist follow-up over time. (A) Rate of tryptase testing each year (number of tryptase tests out of number of drug anaphylaxis reports) within 1 week of anaphylaxis entry. (B) Rate of allergy/immunology specialist follow-up each year (number of patients with follow-up out of number of drug anaphylaxis patients) within 30 days of anaphylaxis entry.