Are you allergic to a drug, forcing your doctor to prescribe a less optimal alternative to treat your ailment? If so, talk to your allergist, and if you are recommended for follow-up, get tested.
According to a recent letter published in Annals of Allergy, Asthma & Immunology, most people evaluated for an allergy to a medication were recommended for further testing. The problem is that nearly one-third never completed the evaluation, and of the ones that did, 92.9% were cleared to have the drug.
That implies many of you out there who believe you are allergic to a specific drug aren’t actually, and that could mean greater costs and less optimal care as your doctor turns to alternatives that are possibly less effective with more side effects.
Dr Monica T Kraft, an assistant professor in the Division of Allergy and Immunology at The Ohio State University Wexner Medical Center, and colleagues wrote:
Our goal was to identify how many patients were not returning for the second appointment for testing and see if there was a trend with any characteristics that might help us identify these patients in advance.
The retrospective chart review assessed 261 adults evaluated for allergies to drugs, with numbers of drug allergies ranging from zero (11.1%) to more than ten (7.7%), although three-quarters of the visits addressed a single allergy.
Antibiotics were most often assessed (55.3%), with penicillin leading (32%), followed by vaccines (14.6%) and nonsteroidal anti-inflammatory drugs (6.6%).
Initial consultations led to 166 (63.6%) recommendations for additional testing to confirm allergy, including skin prick testing with an oral challenge or oral challenge alone. 17.6% were cleared by history or had their allergy reclassified as a side effect or intolerance, 14.2% were instructed to avoid the drug due to a likely allergy, and 2% were admitted for desensitization.
Among those who were recommended for further testing, 54 (32.5%) did not complete the evaluation, including 35 (65%) who never bothered to schedule the follow-up.
We were surprised with how many patients were not following up for testing, essentially leaving their evaluation only half-completed in which the allergist had discussed the possibility of allergy but had not definitively ruled it in or out via available testing.
Unfortunately, we were not able to correlate any factors (demographic, medical, or otherwise) with who was least likely to return, so we were unable to find any predictors for missing the appointment.
Of the 112 patients (67.5%) who completed their evaluations, 104 passed testing, 3 (2.7%) failed, confirming allergy, and 5 (4.5%) had inconclusive results.
This is significant because now that the problem has been quantified, we can see exactly how many patients are not having a complete evaluation. We can now begin to work towards processes to help overcome any barriers to care these patients may have that prevents them from completing their testing.
One takeaway: if you believe you are allergic to a drug and your allergist recommends additional testing, schedule the follow-up and go. You may not actually be allergic, meaning you’ll have more — and better — options for treatment.
- Nearly one-third of patients with drug allergy fail to follow up with challenges — Healio
- Proportion of referred patients who complete recommended drug allergy evaluation — Annals of Allergy, Asthma & Immunology