Drug allergy in older adults: A study from the United States Drug Allergy Registry

Authors

John J. Accarino, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Allison Ramsey, Rochester Regional HealthFollow
Upeka Samarakoon, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Elizabeth Phillips, Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Alexei Gonzalez-Estrada, Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
Iris M. Otani, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, UCSF Medical Center, San Francisco, California.
Xiaoqing Fu, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Aleena Banerji, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Cosby A. Stone, Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
David A. Khan, Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
Kimberly G. Blumenthal, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

Department

Allergy and Immunology

Document Type

Article

Publication Title

Annals of Allergy, Asthma & Immunology

Abstract

Background: Older adults have an increased risk of adverse drug reactions and negative effects associated with alternative antibiotic use. Although the number of antibiotic allergies reported increases with age, the characteristics and outcomes of older adults receiving drug allergy assessment are unknown.

Objective: To assess the characteristics and outcomes of drug allergy evaluations in older adults.

Methods: We considered patients aged above or equal to 65 years enrolled in the United States Drug Allergy Registry (USDAR), a US multisite prospective cohort (January 16, 2019 to February 28, 2022). Data were summarized using descriptive statistics.

Results: Of 1678 USDAR participants from 5 sites, 406 older adults aged above or equal to 65 years (37% 65-69 years, 37% 70-74 years, 16% 75-79 years, and 10% ≥ 80 years) received 501 drug allergy assessments. USDAR older adults were primarily of female sex (69%), White (94%), and non-Hispanic (98%). Most USDAR older adults reported less than or equal to 1 infections per year (64%) and rated their general health as good, very good, or excellent (80%). Of 296 (59%) penicillin allergy assessments in USDAR older adults, 286 (97%) were disproved. Other drug allergy assessments included sulfonamide (n = 41, 88% disproved) and cephalosporin (n = 20, 95% disproved) antibiotics. All 41 drug allergy labels in USDAR participants aged above or equal to 80 years and all 80 penicillin allergy labels in USDAR men aged above or equal to 65 years were disproved.

Conclusion: Older adults represented a quarter of USDAR participants but were neither racially nor ethnically diverse and were generally healthy without considerable antibiotic need. Most older adults presented for antibiotic allergy assessments, the vast majority of which were disproved. Drug allergy assessments may be underutilized in the older adults who are most vulnerable to the harms of unconfirmed antibiotic allergy labels.

First Page

628

Last Page

636.e2

DOI

10.1016/j.anai.2023.07.024

Volume

131

Issue

5

Publication Date

11-1-2023

Medical Subject Headings

Male; Humans; Female; United States (epidemiology); Aged; Prospective Studies; Penicillins (adverse effects); Anti-Bacterial Agents (adverse effects); Drug Hypersensitivity (diagnosis, epidemiology, drug therapy); Hypersensitivity (drug therapy)

PubMed ID

37557950

Recommended Citation

Accarino, J. J., Ramsey, A., Samarakoon, U., Phillips, E., Gonzalez-Estrada, A., Otani, I. M., Fu, X., Banerji, A., Stone, C. A., Khan, D. A., & Blumenthal, K. G. (2023). Drug allergy in older adults: A study from the United States Drug Allergy Registry. Annals of Allergy, Asthma & Immunology, 131 (5), 628-636.e2. https://doi.org/10.1016/j.anai.2023.07.024