K G Blumenthal1,2,3,4, Y Li1,2, W W Acker5,6, Y Chang3,7, A Banerji1,3, S Ghaznavi3,8, C A Camargo1,3,9, L Zhou3,5. 1. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 2. Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 3. Harvard Medical School, Boston, MA, USA. 4. Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA. 5. Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. 6. Geisinger Commonwealth School of Medicine, Scranton, PA, USA. 7. Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. 8. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. 9. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: The epidemiology of multiple drug intolerance syndrome (MDIS) and multiple drug allergy syndrome (MDAS) is poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. METHODS: Patients with ≥3 outpatient encounters at Partners HealthCare System from 2008 to 2015 were included. Patients with MDIS had intolerances to ≥3 drug classes, and patients with MDAS had hypersensitivities to ≥2 drug classes. Psychiatric conditions and comorbidities were defined from the EHR and used in multivariable logistic regression models to assess the relation between anxiety/depression and MDIS/MDAS. RESULTS: Of 746 888 patients, 47 634 (6.4%) had MDIS and 8615 (1.2%) had MDAS; 3171 (0.4%) had both. Anxiety (adjusted odds ratio [aOR] 1.72 [1.65, 1.80]), depression (aOR 1.46 [1.41, 1.52]), and both anxiety and depression (aOR 1.97 [1.86, 2.08]) were associated with increased odds of MDIS. Depression was associated with increased odds of MDAS (aOR 1.41 [1.28, 1.56]), but there were no clear associations with anxiety (aOR 1.13 [0.99, 1.30]) nor both depression and anxiety (aOR 1.13 [0.92, 1.38]). CONCLUSION: While 6% of patients had MDIS, only 1% had MDAS. MDIS was associated with both anxiety and depression; patients with both anxiety and depression had an almost twofold increased odds of MDIS. MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety. Psychological assessments may be useful in the evaluation and treatment of patients with MDIS and MDAS; physiologic causes for MDAS warrant further investigation.
BACKGROUND: The epidemiology of multiple drug intolerance syndrome (MDIS) and multiple drug allergy syndrome (MDAS) is poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. METHODS:Patients with ≥3 outpatient encounters at Partners HealthCare System from 2008 to 2015 were included. Patients with MDIS had intolerances to ≥3 drug classes, and patients with MDAS had hypersensitivities to ≥2 drug classes. Psychiatric conditions and comorbidities were defined from the EHR and used in multivariable logistic regression models to assess the relation between anxiety/depression and MDIS/MDAS. RESULTS: Of 746 888 patients, 47 634 (6.4%) had MDIS and 8615 (1.2%) had MDAS; 3171 (0.4%) had both. Anxiety (adjusted odds ratio [aOR] 1.72 [1.65, 1.80]), depression (aOR 1.46 [1.41, 1.52]), and both anxiety and depression (aOR 1.97 [1.86, 2.08]) were associated with increased odds of MDIS. Depression was associated with increased odds of MDAS (aOR 1.41 [1.28, 1.56]), but there were no clear associations with anxiety (aOR 1.13 [0.99, 1.30]) nor both depression and anxiety (aOR 1.13 [0.92, 1.38]). CONCLUSION: While 6% of patients had MDIS, only 1% had MDAS. MDIS was associated with both anxiety and depression; patients with both anxiety and depression had an almost twofold increased odds of MDIS. MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety. Psychological assessments may be useful in the evaluation and treatment of patients with MDIS and MDAS; physiologic causes for MDAS warrant further investigation.
Authors: Kimberly G Blumenthal; Warren W Acker; Yu Li; Niki S Holtzman; Li Zhou Journal: Ann Allergy Asthma Immunol Date: 2017-01-23 Impact factor: 6.347
Authors: Adrian Wong; Diane L Seger; Kenneth H Lai; Foster R Goss; Kimberly G Blumenthal; Li Zhou Journal: J Allergy Clin Immunol Pract Date: 2018-12-01
Authors: Kimberly G Blumenthal; Nicolas M Oreskovic; Xiaoqing Fu; Fatma M Shebl; Christian M Mancini; Jennifer M Maniates; Rochelle P Walensky Journal: Am J Manag Care Date: 2020-04 Impact factor: 2.229
Authors: Kimberly G Blumenthal; Anna R Wolfson; Yu Li; Claire M Seguin; Neelam A Phadke; Aleena Banerji; Elizabeth Mort Journal: J Patient Saf Date: 2021-12-01 Impact factor: 2.844
Authors: Kimberly G Blumenthal; Yu Li; Joyce T Hsu; Anna R Wolfson; David N Berkowitz; Victoria A Carballo; Jesse M Schwartz; Kathleen A Marquis; Ramy Elshaboury; Ronak G Gandhi; Barbara B Lambl; Monique M Freeley; Alana Gruszecki; Paige G Wickner; Erica S Shenoy Journal: Infect Control Hosp Epidemiol Date: 2019-03-27 Impact factor: 3.254
Authors: Chandra Vethody; Roger Yu; Jacob M Keck; Michelle K Onasch; Cosby A Stone; Elizabeth J Phillips Journal: J Allergy Clin Immunol Pract Date: 2020-09-20