Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Allergy. 2018 Oct;73(10):2012-2023. doi: 10.1111/all.13440.
The epidemiology of multiple drug intolerance syndrome (MDIS) and multiple drug allergy syndrome (MDAS) is poorly characterized. We used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression.
Patients with ≥3 outpatient encounters at Partners HealthCare System from 2008 to 2015 were included. Patients with MDIS had intolerances to ≥3 drug classes, and patients with MDAS had hypersensitivities to ≥2 drug classes. Psychiatric conditions and comorbidities were defined from the EHR and used in multivariable logistic regression models to assess the relation between anxiety/depression and MDIS/MDAS.
Of 746 888 patients, 47 634 (6.4%) had MDIS and 8615 (1.2%) had MDAS; 3171 (0.4%) had both. Anxiety (adjusted odds ratio [aOR] 1.72 [1.65, 1.80]), depression (aOR 1.46 [1.41, 1.52]), and both anxiety and depression (aOR 1.97 [1.86, 2.08]) were associated with increased odds of MDIS. Depression was associated with increased odds of MDAS (aOR 1.41 [1.28, 1.56]), but there were no clear associations with anxiety (aOR 1.13 [0.99, 1.30]) nor both depression and anxiety (aOR 1.13 [0.92, 1.38]).
While 6% of patients had MDIS, only 1% had MDAS. MDIS was associated with both anxiety and depression; patients with both anxiety and depression had an almost twofold increased odds of MDIS. MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety. Psychological assessments may be useful in the evaluation and treatment of patients with MDIS and MDAS; physiologic causes for MDAS warrant further investigation.
多种药物不耐受综合征（MDIS）和多种药物过敏综合征（MDAS）的流行病学特征描述较差。我们使用电子健康记录（EHR）数据描述 MDIS 和 MDAS 的患病率，并研究其与焦虑和抑郁的关系。
纳入 2008 年至 2015 年期间在合作伙伴健康护理系统接受≥3 次门诊就诊的患者。MDIS 患者对≥3 种药物类别不耐受，MDAS 患者对≥2 种药物类别过敏。从 EHR 中定义了精神疾病和合并症，并在多变量逻辑回归模型中用于评估焦虑/抑郁与 MDIS/MDAS 之间的关系。
在 746888 名患者中，47634 名（6.4%）患有 MDIS，8615 名（1.2%）患有 MDAS；3171 名（0.4%）同时患有这两种疾病。焦虑症（调整后优势比[aOR]1.72[1.65，1.80]）、抑郁症（aOR 1.46[1.41，1.52]）和焦虑症和抑郁症（aOR 1.97[1.86，2.08]）均与 MDIS 的发病几率增加相关。抑郁症与 MDAS 的发病几率增加相关（aOR 1.41[1.28，1.56]），但与焦虑症无明显关联（aOR 1.13[0.99，1.30]），也与焦虑症和抑郁症无关（aOR 1.13[0.92，1.38]）。
虽然 6%的患者患有 MDIS，但只有 1%的患者患有 MDAS。MDIS 与焦虑和抑郁均有关，同时患有焦虑症和抑郁症的患者发生 MDIS 的几率几乎增加了两倍。MDAS 与抑郁症的发病几率增加 40%相关，但与焦虑症无显著关联。对 MDIS 和 MDAS 患者的评估和治疗可能需要进行心理评估，MDAS 的生理原因需要进一步研究。
