1 - Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Central
2 - Serviço de Medicina Interna 2.3, Centro Hospitalar Universitário de Lisboa Central
- EAACI Hybrid Congress 2022
BACKGROUND. Drug hypersensitivity reactions are reported in approximately 8-10% of the general population, but many are not confirmed after proper diagnostic approach. Self-reported drug allergies can lead to important limitation for diagnostic approach and treatment. This study intends to evaluate the impact of a drug allergy history on a patient’s clinical approach during hospitalization. METHODS. Retrospective study conducted in an Internal Medicine ward from a tertiary hospital. All patients admitted between January 2018 and December 2020 with a drug allergy report on their electronic medical records were included. Data was collected from electronic medical records.
RESULTS. In this period, 3046 patients were admitted in the Internal Medicine ward and 15% (n=470) had a drug allergy history on their medical records. From those, 14% (n=68) experienced a change in clinical approach directly related to their drug allergy history: 24% (n=16) were denied an exam or procedure, mostly related to radiocontrast administration (n=12) and 76% (n=52) received a second line treatment agent, with most cases (n=45) related to the use of alternative antibiotics. The median (IQR) number of days of use of alternative antibiotics was 7 (3-10) days and it entailed an extra cost of 241% compared to the treatment with the drug in avoidance (35.96 vs. 14.94 euros per patient treated). On this group, 29% of the patients (n=13) had already received the culprit drug in previous hospital admissions and had no reported reaction. On none of the occasions our Allergy and Clinical Immunology Department was called to assist and only 1 patient was posteriorly referenced for further study, which resulted in the exclusion of penicillin allergy after skin and oral provocation tests.
CONCLUSION. The presence of unconfirmed allergy label on electronic medical records had impact on the clinical approach of a relevant number of patients. It is crucial that these patients are properly referred for specialist evaluation. The confirmation or exclusion of the diagnosis will help to choose the proper complementary diagnosis exams and more directed treatments, contributing to reduce complications and healthcare costs.
Palavras Chave: fármacos, hipersensibilidade