Adrian Wong1, Diane L Seger2, Kenneth H Lai3, Foster R Goss4, Kimberly G Blumenthal5, Li Zhou6. 1. Department of Pharmacy Practice, MCPHS University, Boston, Mass; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass. 2. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass; Clinical and Quality Analysis, Partners HealthCare, Somerville, Mass. 3. Clinical and Quality Analysis, Partners HealthCare, Somerville, Mass; Department of Computer Science, Brandeis University, Waltham, Mass. 4. Department of Emergency Medicine, University of Colorado, Aurora, Colo. 5. Department of Medicine, Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass. 6. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass. Electronic address: lzhou@bwh.harvard.edu.
Abstract
BACKGROUND: Hypersensitivity reactions (HSRs) are immunologic responses to drugs. Identification of HSRs documented in the electronic health record (EHR) is important for patient safety. OBJECTIVE: To examine HSR epidemiology using longitudinal EHR data from a large United States health care system. METHODS: Patient demographic information and drug allergy data were obtained from the Partners Enterprise-wide Allergy Repository for 2 large tertiary care hospitals from 2000 to 2013. Drug-induced HSRs were categorized into immediate and delayed HSRs based on typical phenotypes. Causative drugs and drug groups were assessed. The prevalence of HSRs was determined, and sex and racial differences were analyzed. RESULTS: Among 2.7 million patients, 377,474 (13.8%) reported drug-induced HSRs, of whom 70.3% were female and 77.5% were white. A total of 580,456 HSRs were reported, of which 53.1% were immediate reaction phenotypes. Common immediate HSRs included hives (48.8%), itching (15.0%), and angioedema (14.1%). Delayed HSR phenotypes (46.9%) were largely rash (99.0%). Penicillins were associated with the most immediate (33.0%) and delayed (39.0%) HSRs. Although most HSRs were more prevalent in females and white patients, notable differences were identified for certain rare HSRs including acute interstitial nephritis, which appeared more commonly in males (0.02% vs 0.01%, P < .001). Asian patients had more fixed drug eruptions (0.007% vs 0.002%, P = .021) and severe cutaneous adverse reactions (0.05% vs 0.04%, P < .001). CONCLUSIONS: Drug HSRs were reported in 13.8% of patients. Almost one-half of reported immediate HSR phenotypes were hives, and almost all reported delayed HSR phenotypes were rash. HSRs largely affected female and white patients, but differences were identified for specific rare HSRs.
BACKGROUND:Hypersensitivity reactions (HSRs) are immunologic responses to drugs. Identification of HSRs documented in the electronic health record (EHR) is important for patient safety. OBJECTIVE: To examine HSR epidemiology using longitudinal EHR data from a large United States health care system. METHODS:Patient demographic information and drug allergy data were obtained from the Partners Enterprise-wide Allergy Repository for 2 large tertiary care hospitals from 2000 to 2013. Drug-induced HSRs were categorized into immediate and delayed HSRs based on typical phenotypes. Causative drugs and drug groups were assessed. The prevalence of HSRs was determined, and sex and racial differences were analyzed. RESULTS: Among 2.7 million patients, 377,474 (13.8%) reported drug-induced HSRs, of whom 70.3% were female and 77.5% were white. A total of 580,456 HSRs were reported, of which 53.1% were immediate reaction phenotypes. Common immediate HSRs included hives (48.8%), itching (15.0%), and angioedema (14.1%). Delayed HSR phenotypes (46.9%) were largely rash (99.0%). Penicillins were associated with the most immediate (33.0%) and delayed (39.0%) HSRs. Although most HSRs were more prevalent in females and white patients, notable differences were identified for certain rare HSRs including acute interstitial nephritis, which appeared more commonly in males (0.02% vs 0.01%, P < .001). Asian patients had more fixed drug eruptions (0.007% vs 0.002%, P = .021) and severe cutaneous adverse reactions (0.05% vs 0.04%, P < .001). CONCLUSIONS:Drug HSRs were reported in 13.8% of patients. Almost one-half of reported immediate HSR phenotypes were hives, and almost all reported delayed HSR phenotypes were rash. HSRs largely affected female and white patients, but differences were identified for specific rare HSRs.
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