Blumenthal Kimberly G, Wolfson Anna R, Li Yu, Seguin Claire M, Phadke Neelam A, Banerji Aleena, Mort Elizabeth
Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and the Massachusetts General Professional Organization.
J Patient Saf. 2021 Dec 1;17(8):e1595-e1604. doi: 10.1097/PTS.0000000000000568.
The epidemiology of hospital adverse reactions (ARs), particularly allergic reactions, or hypersensitivity reactions (HSRs), is poorly defined. To determine priorities for allergy safety in healthcare, we identified and described safety reports of allergic reactions.
We searched the safety report database of a large academic medical center from April 2006 to March 2016 using 101 complete, truncated, and/or misspelled key words related to allergic symptoms, treatments, and culprits (e.g., medications, foods). Patient and event data were summarized for ARs and two types of ARs, HSRs and side effects/toxicities.
Among 9111 key word search-identified events, 876 (10%) were ARs, of which 436 (5%) were HSRs and the remaining 440 (5%) were side effect reactions or toxicities. Whereas the most common HSRs were simple cutaneous reactions (83%), the following severe immediate HSRs were also identified: shortness of breath (16%), anaphylaxis (14%), and angioedema (12%). Most HSRs were caused by drugs (81%), with antibiotics (26%), particularly β-lactams (11%), and vancomycin (8%), commonly implicated. Other causes of drug HSRs included contrast agents (24%), chemotherapeutics (7%), and opioids (6%). Nondrug HSRs were from blood products (8%), latex (3%), and devices (3%). Food reactions were rarely identified (1%).
We identified ARs, HSRs, and side effects/toxicities, contained in a decade of safety reports at an academic medical center. Allergy safety in the healthcare setting should target approaches to common and severe reactions, with a focus on the safe administration of β-lactams, vancomycin, contrast agents, chemotherapeutics, and opioids. Priority nondrug HSR culprits include blood products, latex, and devices.
医院不良反应（ARs），尤其是过敏反应或超敏反应（HSRs）的流行病学情况尚不清楚。为确定医疗保健中过敏安全的重点，我们对过敏反应的安全报告进行了识别和描述。
我们在2006年4月至2016年3月期间，使用了101个与过敏症状、治疗方法及诱因（如药物、食物）相关的完整、截断或拼写错误的关键词，搜索了一家大型学术医疗中心的安全报告数据库。对ARs以及两种类型的ARs（HSRs和副作用/毒性反应）的患者和事件数据进行了汇总。
在9111个通过关键词搜索识别出的事件中，876例（10%）为ARs，其中436例（5%）为HSRs，其余440例（5%）为副作用反应或毒性反应。虽然最常见的HSRs是单纯皮肤反应（83%），但也识别出了以下严重的速发型HSRs：呼吸急促（16%）、过敏反应（14%）和血管性水肿（12%）。大多数HSRs由药物引起（81%），其中抗生素（26%），尤其是β-内酰胺类（11%）和万古霉素（8%）最为常见。药物HSRs的其他原因包括造影剂（24%）、化疗药物（7%）和阿片类药物（6%）。非药物HSRs来自血液制品（8%）、乳胶（3%）和器械（3%）。食物反应很少见（1%）。
我们在一家学术医疗中心十年的安全报告中识别出了ARs、HSRs以及副作用/毒性反应。医疗保健环境中的过敏安全应针对常见和严重反应采取措施，重点关注β-内酰胺类、万古霉素、造影剂、化疗药物和阿片类药物的安全使用。非药物HSRs的主要诱因包括血液制品、乳胶和器械。
