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Clinical and Molecular Allergy
Published in: Clinical and Molecular Allergy 1/2018

Open Access 01-12-2018 | Research

Importance of hypersensitivity in adverse reactions to drugs in the elderly

Authors: Maria Teresa Ventura, Elisa Boni, Rosa Cecere, Rosalba Buquicchio, Gian Franco Calogiuri, Irene Martignago, Cristoforo Incorvaia, Erminia Ridolo

Published in: Clinical and Molecular Allergy | Issue 1/2018

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Abstract

Background

The use of drugs in the elderly is very extensive because of the frequent occurrence of chronic diseases. Adverse drug reactions (ADRs) commonly occur in geriatric patients receiving multiple therapeutic regimens. In the literature, little attention has been given to ADRs in the elderly, and particularly to allergic reactions.

Objective

The aim of the present study is to provide data on possible inappropriate prescriptions in the elderly in relation to allergic reactions and to identify a list of drugs which are likely inducers of allergic reactions.

Methods

We retrospectively evaluated ADRs in patients referring to Immunoallergy Unit of Hospital Policlinico in Bari on the basis of Beers criteria. Among adverse reactions, hypersensitivity reactions were extracted and a comparison between different age groups was assessed.

Results

Out of 823 patients with ADRs, in 30.6% hypersensitivity drug reactions (HDR) were diagnosed. Data about drug intake, comorbidities and clinical presentation were collected, aiming to identify possible risk factors. An evaluation of drugs most commonly involved was assessed.

Conclusions

HDR are reported to represent 5–10% of all ADRs, while in our study population the prevalence was about 30%. This suggests the need to develop strategies to minimize the incidence of drug allergy in the elderly, as well to reduce the phenomenon of inappropriate prescriptions.
Literature
1.
Onder G, Pedone C, Landi F. Adverse drug reactions as a cause of hospital admissions: results of Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc. 2002;50(12):33–52.CrossRef
2.
Goldberg RM, Mabee J, Chan L, Wong S. Drug-drug and drug-disease interactions in the emergency department: analysis of a high-risk population. Am J Emerg Med. 1996;14(5):447–50.CrossRefPubMed
3.
Meyer BR. Clinical Pharmacology and ageing. In: Grimley Evans J, Franklin Williams T, Lynn Beattie B, Michael J-P, Wilcock G, editors. Textbook of geriatric medicine. 2nd ed. Oxford: Oxford University Press; 2003. p. 127–36.
4.
Corsonello A, Pedone C, Corica F. Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus. J Gerontol A Biol Sci Med Sci. 2005;60(9):1147–51.CrossRefPubMed
5.
Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. Am J Emerg Med. 2007;14:447–50.
6.
Knowles SR, Uetrecht J, Shear NH. Idiosyncratic drug reactions: the reactive metabolite syndromes. Lancet. 2000;35:1587–91.CrossRef
7.
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356:1255–97.CrossRefPubMed
8.
Johansson SG, Hourihane JOB, et al. Position paper. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56:813–24.CrossRef
9.
Farnam K, Chang C, Teuber S, Gershwin ME. Nonallergic drug hypersensitivity reactions. Int Arch Allergy Immunol. 2012;159:327–45.CrossRefPubMed
10.
Beers MH, Ouslander JG, Rollingher I. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151(9):1825–32.CrossRefPubMed
11.
Stuck AE, Beers MH, Steiner A. Inappropriate medication use in community residing older persons. Arch Intern Med. 1994;154(19):2195–200.CrossRefPubMed
12.
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly, An update. Arch Intern Med. 1997;157(14):1531–6.CrossRefPubMed
13.
Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickizer SW, Meyer GS. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA. 2001;286(28):2823–9.CrossRefPubMed
14.
Fick DM, Cooper JW, Wade W. Updating the Beers criteria for potentially inappropriate medication use in older adults—results of a US consensus Panel of experts. Arch Intern Med. 2003;163:2716–24.CrossRefPubMed
15.
Demoly P, Kropf R, Bircher A, Pichler WJ. Drug hypersensitivity: questionnaire. EAACI interest group on drug hypersensitivity. Allergy. 1999;54(9):999–1003.CrossRefPubMed
16.
Ventura MT, Sanapo F, Calogiuri GF, Satriano F. Anaphylaxis induced by intramuscular betamethasone disodium phosphate: reflections on a clinical case. Int J Immunopathol Pharmacol. 2007;20:387–91.CrossRefPubMed
17.
Rawlins MD, Thompson JW. Pathogenesis of adverse drug reactions. In: Davies DM, editor. Textbook of adverse drug reactions. Oxford: Oxford University Press; 1977. p. 10–45.
18.
Gutiérrez-Macías A, Lizarralde-Palacios E, Martínez-Odriozola P, Miguel-De la Villa F. Fatal allopurinol hypersensitivity syndrome after treatment of asymptomatic hyperuricemia. BMJ. 2005;331:623–4.CrossRefPubMedPubMedCentral
19.
Lee HY, Ariyasinghe JT, Thirumoorthy T. Allopurinol hypersensitivity syndrome: a preventable severe cutaneous adverse reaction? Singap Med J. 2008;49:384–7.
20.
Yun J, Mattsson J, Schnyder K, Fontana S, Largiader CR, Pichler WJ, Yerly D. Allopurinol hypersensitivity is primarily mediated by dose dependent oxypurinol—specific T-cell response. Clin Exp Allergy. 2013;43(11):1246–55.CrossRefPubMed
21.
Demoly P, Bousquet J. Epidemiology of drug allergy. Curr Opin Allergy Clin Immunol. 2001;1:305–10.CrossRefPubMed
22.
Guglielmi L, Guglielmi P, Demoly P. Drug hypersensitivity: epidemiology and risk factors. Curr Pharm Des. 2006;12:3309–12.CrossRefPubMed
23.
Ventura MT, Muratore L, Calogiuri GF, et al. Allergic and pseudoallergic reactions induced by glucorticoids: a review. Curr Pharm Des. 2003;9:1956–64.CrossRefPubMed
24.
Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003;38:843–53.CrossRefPubMed
25.
Beyth RJ, Shorr RI. Epidemiology of adverse drug reactions in the elderly by drug class. Drugs Aging. 1999;14(3):231–9.CrossRefPubMed
26.
Ventura MT, Laddaga R, Cavallera P, Pugliese P, Tummolo R, Buquicchio R, Pierucci P, Passalacqua G. Adverse drug reactions as the cause of emergency department admission: focus on the elderly. Immunopharmacol Immunotoxicol. 2010;32:426–9.CrossRefPubMed
27.
Haddi C, Charpin D, Tofforeau M, Kulling G, Lanteaume A, Kleisbauer JP. Atopy and systemic reactions to drugs. Allergy. 1990;45:236–9.CrossRefPubMed
28.
Barranco P, Lopez-Serrano MC. General and epidemiological aspects of allergic drug reactions. Clin Exp Allergy. 1998;28(4):61–2.PubMed
29.
30.
Jala VR, Haribabu B. Leukotrienes and atherosclerosis: new roles for old mediators. Trends Immunol. 2004;25:315–22.CrossRefPubMed
31.
Dwyer JH, Allayee H, Dwyer KM, Fan J, Wu H, Mar R, Lusis AJ, Mehrabian M. Arachidonate 5-lipoxygenase promoter genotype, dietary arachidonic acid and atherosclerosis. N Engl J Med. 2004;350:29–37.CrossRefPubMed
32.
Brooks BM, Thomas AL, Coleman JW. Benzylpenicillin differentially conjugates to IFNγ, TNFα, IL-1β, IL-4 and IL-13 but selectively reduces IFNγ activity. Clin Exp Immunol. 2003;131:268–74.CrossRefPubMedPubMedCentral
33.
Sordillo JE, Lange NE, Tarantini L, Bollati V, Zanobetti A, Sparrow D, Vokonas P, Schwartz J, Baccarelli A, Demeo D, Litonjua AA. Allergen sensitization is associated with increased DNA methylation in older men. Int Arch Allergy Immunol. 2013;161:37–43.CrossRefPubMed
34.
Ventura MT, Viola M, Calogiuri GF, Gaeta F, Pesole O, Romano A. Hypersensitivity reactions to complementary and alternative medicine products. Curr Pharm Des. 2006;12:3393–9.CrossRefPubMed
35.
Ramirez E, Cabana R, Laserna LS, Fiandor A, Tong H, Prior N, Calderon O, Medrano N, Boblea I, Frias J, Quirce S. Proton pump inhibitors are associated with hypersensitivity reactions to drugs in hospitalized patients: a case control need in a retrospective cohort study. Clin Exp Allergy. 2013;43:344–52.CrossRefPubMed
36.
Riemer AB, Gruber S, Pali-Scholl I, Kinaciyan T, Untersmayr E, Jensen-Jarolim E. Suppression of gastric acid increases the risk of developing immunoglobulin E-mediated drug hypersensitivity: human diclofenac sensitization and a murine sensitization. Clin Exp Allergy. 2010;40:486–93.CrossRefPubMed
Metadata
Title
Importance of hypersensitivity in adverse reactions to drugs in the elderly
Authors
Maria Teresa Ventura
Elisa Boni
Rosa Cecere
Rosalba Buquicchio
Gian Franco Calogiuri
Irene Martignago
Cristoforo Incorvaia
Erminia Ridolo
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Clinical and Molecular Allergy / Issue 1/2018
Electronic ISSN: 1476-7961
DOI
https://doi.org/10.1186/s12948-018-0083-x

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