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The patient who reports a drug allergy.
The BMJ ( IF 30.223 ) Pub Date : 2020-01-14 , DOI: 10.1136/bmj.l6791
Robin Ferner,Patricia McGettigan

Non-immunological adverse drug reactions are often incorrectly labelled “drug allergy”
Unnecessarily labelling patients “allergic” to a drug can be harmful and can deny them best treatment
A detailed history can help clinicians decide if re-administration is safe, although specialist tests may be necessary
What should clinicians do when a patient gives a history of a “drug allergy”? If it really is an allergy—an immunological reaction—or a serious adverse drug reaction (ADR), then patients risk serious harm unless they avoid the drug. But often, patients and healthcare professionals use “drug allergy” to mean any suspected ADR. Accepting a “drug allergy” at face value can unnecessarily deprive the patient of a potentially useful treatment. It may directly cause harm: patients labelled “allergic to penicillin” are more likely to become infected with methicillin resistant Staphylococcusaureus or Clostridiodes difficile, for instance.1
In some cases it may be safe for a patient to take, perhaps in a lower dose, a drug that caused an ADR. Here we offer a guide to help patients and practitioners when the issue of “drug allergy” arises.
A scheme for assessing a patient who describes a drug allergy, based on our experience, is set out in figure 1. Begin by trying to establish if the harm was caused by medication, or something else. If it was an ADR, consider whether the reaction was serious, whether it was likely to be a true allergy, and whether it might have been related to the dose.
An algorithm to guide decisions when a patient reports a “drug allergy”
When taking a drug history, it is better to ask: “Have you had a bad experience with any medicines or drugs?” rather than enquiring about drug allergy (see box 1 for definitions). If the patient volunteers a “drug allergy,” a detailed …
更新日期:2020-01-14

 

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