Jagpal Parbir K, Alshareef Saad, Marriott John F, Krishna Mamidipudi Thirumala
Institute of Clinical Sciences University of Birmingham Birmingham UK.
University Hospitals Birmingham NHS Foundation Trust Birmingham UK.
Clin Transl Allergy. 2022 Aug 22;12(8):e12190. doi: 10.1002/clt2.12190. eCollection 2022 Aug.
Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco-economics of MDAS and MDIS.
Systematic literature search across 11 databases (01 January 2000-06 November 2020) for MDIS, MDAS and related terminology. Studies were reviewed for quality of evidence and risk of bias by employing Critical Appraisal Skills Programme cohort study checklist. A narrative synthesis approach facilitated by systematic textual descriptions, tabulation and thematic analysis was adopted.
There was heterogeneity in terminology and methodology. Few studies applied standard drug allergy diagnostic methods. There is some evidence to suggest that multiple drug hypersensitivity syndrome (MDHS; i.e., confirmed allergies in MDAS) is a distinct clinical entity. Prevalence of MDIS and MDAS labels in unselected & selected populations varied between 2.1%-6.4% & 4.9%-90% and 1.2% & 0%-36% respectively. Reported risk factors included female gender, increasing age, body mass index, anxiety, depression, co-morbidities, concurrent allergies and increased healthcare utilization. Drugs commonly implicated were antibiotics and non-steroidal anti-inflammatory drugs. No studies relating to clinical impact and pharmaco-economics were found.
There is considerable burden of MDAS and MDIS labels. Data needs cautious interpretation as majority of studies described involved unverified labels. Despite this limitation and heterogeneity of studies, there is some evidence to suggest that MDHS is a distinct clinical entity. Well-designed multi-centre studies applying standardized terminology and diagnostic methodology are needed to gain further insight into these conditions.
多种药物过敏和多种药物不耐受综合征（MDAS/MDIS）标签对临床护理造成了阻碍，并且关于这些病症的知识有限。本系统评价调查了MDAS和MDIS的特征、流行病学、危险因素、临床影响和药物经济学。
在11个数据库（2000年1月1日至2020年11月6日）中对MDIS、MDAS及相关术语进行系统的文献检索。采用关键评估技能计划队列研究清单对研究的证据质量和偏倚风险进行评估。采用系统文本描述、列表和主题分析辅助的叙述性综合方法。
术语和方法存在异质性。很少有研究应用标准的药物过敏诊断方法。有证据表明，多种药物超敏反应综合征（MDHS，即MDAS中确诊的过敏）是一种独特的临床实体。未选择人群和选择人群中MDIS和MDAS标签的患病率分别在2.1%-6.4%和4.9%-90%以及1.2%和0%-36%之间。报告的危险因素包括女性、年龄增长、体重指数、焦虑、抑郁、合并症、并发过敏和医疗保健利用率增加。常见的相关药物是抗生素和非甾体抗炎药。未发现与临床影响和药物经济学相关的研究。
MDAS和MDIS标签带来了相当大的负担。由于大多数描述的研究涉及未经证实的标签，数据需要谨慎解读。尽管存在这一局限性和研究的异质性，但有证据表明MDHS是一种独特的临床实体。需要开展设计良好的多中心研究，应用标准化术语和诊断方法，以进一步深入了解这些病症。
