Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Background Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco‐econom...

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Published in:Clinical and translational allergy Vol. 12; no. 8; pp. e12190 - n/a
Main Authors: Jagpal, Parbir K., Alshareef, Saad, Marriott, John F., Thirumala Krishna, Mamidipudi
Format: Journal Article
Language:English
Published: England John Wiley & Sons, Inc 01-08-2022
John Wiley and Sons Inc
Wiley
Subjects:
Allergies
Antibiotics
Antimicrobial agents
Asthma
Cohort analysis
Drug dosages
Epidemiology
multiple drug allergy
multiple drug allergy syndrome
multiple drug hypersensitivity
multiple drug intolerance
multiple drug intolerance syndrome
Original
Patients
Penicillin
Risk factors
Side effects
Simplification
Systematic review
Italy
multiple drug allergy syndrome
multiple drug intolerance
multiple drug hypersensitivity
multiple drug intolerance syndrome
multiple drug allergy
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Summary:Background Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco‐economics of MDAS and MDIS. Methods Systematic literature search across 11 databases (01 January 2000–06 November 2020) for MDIS, MDAS and related terminology. Studies were reviewed for quality of evidence and risk of bias by employing Critical Appraisal Skills Programme cohort study checklist. A narrative synthesis approach facilitated by systematic textual descriptions, tabulation and thematic analysis was adopted. Results There was heterogeneity in terminology and methodology. Few studies applied standard drug allergy diagnostic methods. There is some evidence to suggest that multiple drug hypersensitivity syndrome (MDHS; i.e., confirmed allergies in MDAS) is a distinct clinical entity. Prevalence of MDIS and MDAS labels in unselected & selected populations varied between 2.1%–6.4% & 4.9%–90% and 1.2% & 0%–36% respectively. Reported risk factors included female gender, increasing age, body mass index, anxiety, depression, co‐morbidities, concurrent allergies and increased healthcare utilization. Drugs commonly implicated were antibiotics and non‐steroidal anti‐inflammatory drugs. No studies relating to clinical impact and pharmaco‐economics were found. Conclusion There is considerable burden of MDAS and MDIS labels. Data needs cautious interpretation as majority of studies described involved unverified labels. Despite this limitation and heterogeneity of studies, there is some evidence to suggest that MDHS is a distinct clinical entity. Well‐designed multi‐centre studies applying standardized terminology and diagnostic methodology are needed to gain further insight into these conditions.
Bibliography:John F. Marriott and Mamidipudi Thirumala Krishna: joint senior authors.
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ISSN:2045-7022
2045-7022
DOI:10.1002/clt2.12190