Drug-Induced Anaphylaxis Documented in Electronic Health Records

J Allergy Clin Immunol Pract. 2019 Jan;7(1):103-111. doi: 10.1016/j.jaip.2018.06.010. Epub 2018 Jun 30.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Allergens / immunology
  • Anaphylaxis / diagnosis
  • Anaphylaxis / epidemiology*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Inflammatory Agents, Non-Steroidal / immunology
  • Delivery of Health Care / statistics & numerical data*
  • Drug Hypersensitivity / diagnosis
  • Drug Hypersensitivity / epidemiology*
  • Electronic Health Records / statistics & numerical data*
  • European Continental Ancestry Group
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Male
  • Penicillins / adverse effects*
  • Penicillins / immunology
  • Prevalence
  • Risk Factors
  • Sex Factors
  • Sulfonamides / adverse effects*
  • Sulfonamides / immunology
  • Tryptases / blood

Substances

  • Allergens
  • Anti-Inflammatory Agents, Non-Steroidal
  • Penicillins
  • Sulfonamides
  • Tryptases