Drug Allergy in Adults at a Multidisciplinary Hospital: Prevalence Assessment Using the Global Trigger Tool

INTRODUCTION. Allergic drug reactions in hospitalised patients limit the opportunities for rational pharmacotherapy and increase the risk of polypharmacy due to the need for managing the patient’s condition and prescribing anti-allergic agents. An objective assessment of the prevalence of inpatient allergic drug reactions and a categorisation of medicinal products are critical for treatment adjustment and will lead to both a significant improvement in clinical outcomes for patients and a reduction in the financial burden for the healthcare system. The Global Trigger Tool (GTT) methodology is based on analysing medical records and capturing specific triggers, which makes the GTT easily applicable in clinical practice.

AIM. This study aimed to investigate the applicability of the GTT in studying the prevalence of allergic drug reactions in patients admitted to a multidisciplinary hospital.

MATERIALS AND METHODS. This study used the GTT in retrospective pharmacoepidemiological analysis of medical records of patients admitted to City Clinical Hospital 24 of the Moscow City Health Department from 1 October 2022 to 1 April 2023. The study included medical records of patients treated in the internal medicine and surgery departments during the specified period and excluded those of allergology patients.

RESULTS. A total of 8,934 patients were admitted to the internal medicine and surgery departments during the analysed period. Triggers suggestive of allergic drug reactions were identified in 229 (2.6%) of their medical records. This would correspond to a prevalence of 2,563 cases per 100,000 patients. However, the analysis of prescriptions, diary cards, and clinical and laboratory findings identified only 52 (22.7%) true triggers of allergic drug reactions. In the remaining 177 (77.3%) cases, the triggers were classified as false positives, as anti-allergic agents were prescribed before or concomitantly with the suspected medicinal product, presumably, to prevent potential allergic reactions. The main groups of medicinal products suspected to cause allergic reactions were systemic antimicrobial agents (22 (40.7%) products, in particular, 14 (20.3%) beta-lactam antibiotics) and monoclonal antibodies (21 (38.9%) products).

CONCLUSIONS. The true prevalence of allergic drug reactions was 0.58%, which corresponds to 582 cases per 100,000 patients. The study demonstrated the effectiveness of the GTT in identifying allergic drug reactions in real-world clinical practice. The exclusion of false triggers, first of all, anti-allergic agents prescribed as prophylaxis, significantly reduces the bias in estimating the true prevalence of allergic drug reactions and the risk of overdiagnosis.

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