Sousa-Pinto Bernardo, Fonseca João Almeida, Gomes Eva Rebelo
MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal.
Ann Allergy Asthma Immunol. 2017 Oct;119(4):362-373.e2. doi: 10.1016/j.anai.2017.07.009. Epub 2017 Aug 2.
Patients reporting drug allergy are treated with second-line therapies, with possible negative clinical and health consequences.
To assess the prevalence of self-reported drug allergy.
We performed a systematic review of observational studies assessing the prevalence of self-reported drug allergy. We searched 4 electronic databases. From selected studies, we extracted data on self-reported drug allergy prevalence, study design, participants' demographic characteristics, reported clinical manifestations, and suspected culprit drugs. We performed a random-effects meta-analysis followed by a meta-regression.
Fifty-three studies were included in the systematic review, assessing a total of 126,306 participants, of whom 8.3% (range across studies 0.7-38.5%) self-reported drug allergy. Cutaneous manifestations were reported by 68.2% of participants, and anaphylactic or systemic reactions were reported by 10.8%. Antibiotics, nonsteroidal anti-inflammatory drugs, and anesthetics were the most frequently reported culprit drug classes. The frequency of self-reported drug allergy was higher in female (11.4%) than in male (7.2%) patients, adults (10.0%) than in children (5.1%), and in studies in the medical setting (15.9% in inpatients, 11.4% in outpatients) than in the general population (5.9%). The meta-analysis rendered a pooled prevalence of 7.9% (95% confidence interval 6.4-9.6), and the meta-regression identified study region, participants' age group, and study setting as factors associated with significant heterogeneity. Confirmation tests (including skin, in vitro, and drug provocation tests) were performed in only 3 studies.
The prevalence of self-reported drug allergy is highly variable and is higher in female patients, adults, and inpatients. To overcome this variability, further studies using confirmation tests are needed.
报告药物过敏的患者接受二线治疗，可能会产生负面的临床和健康后果。
评估自我报告的药物过敏患病率。
我们对评估自我报告药物过敏患病率的观察性研究进行了系统评价。我们检索了4个电子数据库。从选定的研究中，我们提取了关于自我报告药物过敏患病率、研究设计、参与者的人口统计学特征、报告的临床表现以及可疑致病药物的数据。我们进行了随机效应荟萃分析，随后进行了荟萃回归分析。
53项研究纳入了系统评价，共评估了126,306名参与者，其中8.3%（各研究范围为0.7 - 38.5%）自我报告有药物过敏。68.2%的参与者报告有皮肤表现，10.8%报告有过敏或全身反应。抗生素、非甾体抗炎药和麻醉剂是最常报告的致病药物类别。自我报告的药物过敏频率在女性患者（11.4%）中高于男性患者（7.2%），在成人（10.0%）中高于儿童（5.1%），在医疗环境中的研究中（住院患者为15.9%，门诊患者为11.4%）高于一般人群（5.9%）。荟萃分析得出合并患病率为7.9%（95%置信区间6.4 - 9.6），荟萃回归分析确定研究地区、参与者年龄组和研究环境是与显著异质性相关的因素。仅3项研究进行了确认试验（包括皮肤试验、体外试验和药物激发试验）。
自我报告的药物过敏患病率差异很大，在女性患者、成人和住院患者中更高。为克服这种变异性，需要使用确认试验进行进一步研究。
