Nurenberg Jeffry R, Schleifer Steven J
Greystone Park Psychiatric Hospital, Morris Plains, NJ 07950, USA.
J Psychiatr Pract. 2009 Nov;15(6):489-92. doi: 10.1097/01.pra.0000364293.31823.63.
The incidence of allergic reactions to antipsychotic agents is not well known but would be expected to be low. However, pharmacy records at a large state psychiatric hospital indicated surprisingly high rates of such allergies. We hypothesized that these high rates of reported allergies in the pharmacy database would not be supported by clinical history, but rather that they represented other side effects or past uncritical acceptance of casual patient reports. Method. Patients listed as having experienced allergies to antipsychotic medications were interviewed by two psychiatrists and any clinical evidence that suggested an allergy was noted. Results. Of 585 patients who were hospitalized on the day the data were reviewed, 138 patients (23.6%) were identified by the pharmacy as allergic to an antipsychotic medication, 79 of whom were available and consented to be interviewed. Of these 79 patients, 7 (8.9%) provided evidence of a true allergy and 12 (15.2%) provided evidence that suggested a remote possibility of an allergy. Of the 60 "allergic" patients who provided no evidence of an allergy, 57% reported a non-allergic adverse drug reaction (ADR) that may have accounted for the allergy assignment and 32% reported possible symptoms that might have done so. Length of stay was possibly associated with an unsupported allergy designation (p <0.07). Reported allergies to other psychotropic agents (p <0.02) or to nonpsychotropic agents (p <0.07) were associated with evidence of a "true" allergy to an antipsychotic agent. Conclusions. Allergies to antipsychotic medications may be much less common than suggested by clinical records. The examination of focused clinical histories from patients who have been reported to experience such "allergies" would likely expand the pool of available medications for many patients.
抗精神病药物过敏反应的发生率尚不清楚，但预计较低。然而，一家大型州立精神病院的药房记录显示，此类过敏反应的发生率出奇地高。我们推测，药房数据库中报告的这些高过敏率在临床病史中不会得到证实，相反，它们代表了其他副作用或过去对患者随意报告的不加批判的接受。方法。两位精神科医生对被列为对抗精神病药物过敏的患者进行了访谈，并记录了任何提示过敏的临床证据。结果。在数据审查当天住院的585名患者中，药房确定有138名患者（23.6%）对一种抗精神病药物过敏，其中79名患者可联系并同意接受访谈。在这79名患者中，7名（8.9%）提供了真正过敏的证据，12名（15.2%）提供了提示可能过敏的证据。在60名未提供过敏证据的“过敏”患者中，57%报告了可能导致过敏认定的非过敏性药物不良反应（ADR），32%报告了可能导致过敏认定的症状。住院时间可能与无依据的过敏认定有关（p<0.07）。报告对其他精神药物（p<0.02）或非精神药物（p<0.07）过敏与对抗精神病药物“真正”过敏的证据有关。结论。抗精神病药物过敏可能比临床记录显示的要少见得多。对报告有此类“过敏”的患者进行有针对性的临床病史检查，可能会为许多患者扩大可用药物的范围。
