The drug allergy history tool (DAHT): Validation of a patient-reported survey instrument

Authors

Kimberly G. Blumenthal, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Daniel A. Gundersen, Harvard Medical School, Boston, Mass; Survey and Qualitative Methods Core, Dana Farber Cancer Institute, Boston, Mass.
Liam R. Smith, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
Brett Nava-Coulter, Survey and Qualitative Methods Core, Dana Farber Cancer Institute, Boston, Mass.
Andrew King, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Elizabeth J. Phillips, Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
Alexei Gonzalez-Estrada, Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, Ariz.
Iris M. Otani, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco Medical Center, San Francisco, Calif.
Allison Ramsey, Rochester Regional HealthFollow
Aleena Banerji, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Timothy G. Chow, Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.
Cosby A. Stone, Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
Whitney A. Salinas, Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.
David A. Khan, Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.

Department

Allergy and Immunology

Document Type

Article

Publication Title

The Journal of Allergy and Clinical Immunology

Abstract

BACKGROUND: While the reaction history is critical for drug allergy evaluations and is typically self-reported, there is no validated survey instrument to collect drug allergy history from patients.

OBJECTIVE: We validated a survey instrument that collects patient-reported drug allergy history.

METHODS: The drug allergy history tool (DAHT) was revised after 3 rounds of cognitive testing, assessed for reliability through test-retest comparisons, and assessed for quality and validity through a concordance analysis against electronic health record allergist documentation. Participants completing testing and surveys had 1 or more drug allergies and were recruited from allergy clinics at Massachusetts General Hospital. Primary evaluative measures were percentage agreement and kappa statistic values.

RESULTS: The DAHT was completed by 79 individuals (mean age, 49 [SD 17] years, 85% female, 85% White, 11% Hispanic ethnicity), 29 with single drug allergy labels and 50 with multiple drug allergy labels. The most common drug allergy labels were penicillins (77%), sulfonamides (32%), cephalosporins (15%), and nonsteroidal anti-inflammatory drugs (8%). The DAHT achieved acceptable test-retest reliability (median κ = 0.64, median agreement = 86%). The DAHT achieved a more complete allergy history than allergist documentation in the electronic health record, with lower median item uncertainty (21% DAHT vs 79% electronic health record) with fair concordance (median κ = 0.21, median agreement = 67%) between the two data sources.

CONCLUSION: The DAHT is a reliable and valid source of patient-reported drug allergy information. This tool can be used in clinical care and clinical research to obtain standardized patient-reported drug allergy history.

First Page

734

Last Page

742

DOI

10.1016/j.jaci.2025.02.027

Volume

156

Issue

3

Publication Date

9-1-2025

Medical Subject Headings

Humans; Drug Hypersensitivity (diagnosis, epidemiology); Female; Male; Middle Aged; Adult; Surveys and Questionnaires; Reproducibility of Results; Self Report; Medical History Taking; Aged; Electronic Health Records

PubMed ID

40049420

Recommended Citation

Blumenthal, K. G., Gundersen, D. A., Smith, L. R., Nava-Coulter, B., King, A., Phillips, E. J., Gonzalez-Estrada, A., Otani, I. M., Ramsey, A., Banerji, A., Chow, T. G., Stone, C. A., Salinas, W. A., & Khan, D. A. (2025). The drug allergy history tool (DAHT): Validation of a patient-reported survey instrument. The Journal of Allergy and Clinical Immunology, 156 (3), 734-742. https://doi.org/10.1016/j.jaci.2025.02.027