Adverse reactions during drug challenges: a single US institution's experience |
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| Authors: | Leon Kao Jessica Rajan Lonnie Roy Eric Kavosh David A Khan |
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| Institution: | 1. Division of Allergy and Immunology at the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas;2. Health Systems Research Department, Parkland Health & Hospital System, Dallas, Texas;1. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi, Republic of Korea;2. Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi, Republic of Korea;1. Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Australia;2. Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia;3. Royal Brisbane and Womens Hospital, Queensland, Australia;4. Cancer Epidemiology Center, The Cancer Council Victoria, Melbourne, Australia;6. School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia;5. National Health and Medical Research Council of Australia, Centre of Research Excellence in Chronic Respiratory Disease, Menzies Research Institute Tasmania, Hobart, Australia;1. Department of Medical Genetics, Ajou University School of Medicine, Suwon, Republic of Korea;2. Division of Epidemiology and Health Index, Center for Genome Science, Korea Centers for Disease Control & Prevention, Cheongwon, Republic of Korea;3. Department of Biomedical Laboratory Science, Molecular Diagnosis Research Institute, Namseoul University, Cheonan, Republic of Korea;4. Department of Health Administration, Namseoul University, Cheonan, Republic of Korea;5. Dongwoodang Pharmaceutical Co., Ltd, Kyeongsan, Republic of Korea;6. Department of Biomedical Engineering, School of Medicine, Kyung Hee University, Seoul, Republic of Korea;7. Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea |
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| Abstract: | BackgroundDrug challenge is a useful tool when diagnostic testing lacks predictive value for a questionable history of drug allergy. Placebo-controlled drug challenge studies demonstrate that a significant number of patients report purely subjective symptoms to placebo.ObjectiveTo evaluate the safety and rate of adverse effects when performing drug challenges and to identify predictive factors for occurrences of subjective symptoms during drug challenges.MethodsWe performed a 6-year, retrospective medical record review of patients who underwent drug challenges by members of the Allergy and Immunology Division after consultation deemed drug challenges to be appropriate. Statistical analysis was performed to compare the proportion of patients with subjective symptoms based on certain factors, including sex, age, number of listed drug allergies, interval from historical drug reaction to the drug challenge, and types of historical reaction.ResultsA total of 114 patients underwent 123 drug challenges. Only 1 patient was deemed to have a true positive drug challenge result. Twenty patients reported subjective symptoms during graded challenge, all of which were not deemed a positive challenge. There was a significantly higher proportion of patients who reported subjective symptoms in females, those with a higher number of listed drug allergies, and those whose historical reactions were primarily subjective in nature.ConclusionDrug challenges are safe procedures in appropriately selected patients. A number of patients report subjective symptoms during drug challenges. Identifying patients at high risk for subjective symptoms may assist in determining whether placebo-controlled drug challenges should be performed. |
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