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Relevance of drug allergy history after allogeneic hemopoietic stem cell transplantation

Bone Marrow Transplantation volume 40, pages 179–180 (2007)Cite this article

A detailed allergy history is central to all history taking and medical records. It is also mandatory before anesthesia or contrast exposure. Owing to medical legal consequences and the availability of a wider drug repertoire, drug re-challenges or desensitization are now less frequently performed. There are few systematic data on the validity of drug reaction history after allogeneic stem cell transplantation (HSCT).1

The central, computerized patient registry of the Hong Kong Hospital Authority requires mandatory entry of all drug allergy history and it automatically documents all subsequent drug prescriptions and reactions. Among 763 consecutive adult HSCT recipients, a known history of pre-HSCT allergic drug reaction was registered in 175 cases (22.9%). The most commonly implicated drugs were penicillin group antibiotics (including cephalosporin and imipenem, n=64), allopurinol (n=30), cotrimoxazole (n=21), vancomycin (n=14), intravenous contrast (n=9) and cytosine arabinoside (n=10). Multiple drug allergies were documented in 55 cases (32% of allergic patients), and skin rash was the most common manifestation (95.4% of cases). Skin tests to document sensitivity were not performed. At a median follow-up of 37 months, 16 patients had documented re-exposure to the same mediation (9.1%, median 8 months, range 2–24 months after HSCT). The overriding clinical decisions for exposure were based on microbial sensitivity, severity of patient condition and intolerance or inefficiency of alternative agents (for example pentamidine inhalation).2 The re-challenged drugs included vancomycin (n=4), cotrimoxazole (n=6), allopurinol (n=3), tienam (n=2) and amphotericin (n=1). No adverse reaction was documented in any case with no desensitization,3 even in relapsed patients with theoretical loss of donor chimerism.

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Acknowledgements

I thank Miss Christina Cheung of the information technology department for technical assistance on data retrieval, and Queen Mary Hospital pharmacy for its support.

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  1. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China. E-mail: auwing@hotmail.com,

    W Y Au

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Au, W. Relevance of drug allergy history after allogeneic hemopoietic stem cell transplantation. Bone Marrow Transplant 40, 179–180 (2007). https://doi.org/10.1038/sj.bmt.1705705

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