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      Variabilidad en el registro de alergias entre niveles asistenciales Translated title: Variability in allergies registration between care levels

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          Abstract

          RESUMEN Objetivo : El objetivo del estudio es comparar el grado de coincidencia en el registro de alergias entre las aplicaciones informáticas de los distintos niveles asistenciales (atención primaria y hospitalaria). Métodos: Estudio observacional descriptivo retrospectivo de 2 meses de duración en el que participaron todas las unidades clínicas con prescripción electrónica. Se incluyó en el estudio a todos los pacientes ingresados con al menos una alergia registrada en la aplicación informática hospitalaria. Se cuantificó el porcentaje de alergias registradas en hospital, atención primaria o ambas. Resultados : Se incluyeron 723 pacientes en los que se registraron 1.280 alergias. El ratio de alergias por paciente fue 1,77. La media de edad fue 62±37 años y el 58,37% eran mujeres. El 80,47% de las alergias registradas fueron farmacológicas. De manera global el 42,11% de todas las alergias fueron registradas en ambas aplicaciones. El 21,20% de las alergias no farmacológicas y el 47,18% de las alergias farmacológicas fueron registradas en ambas aplicaciones. Del total de las alergias farmacológicas detectadas en el estudio, el 68,08% estaban registradas en atención primaria y el 79,13% en atención hospitalaria. Respecto al total de las alergias no farmacológicas el 37,20% estaban registradas en atención primaria y el 84% en la aplicación de atención hospitalaria. Conclusiones: En nuestro estudio hemos encontrado una gran variabilidad en el registro de alergias en los diferentes niveles asistenciales. En menos de la mitad de los casos se registra la alergia en ambos niveles.

          Translated abstract

          SUMMARY This study aims at comparing the coincidence degree between different allergy-recording computer applications that can be found in distinct levels of the health care system (primary care and hospital care). Methods: Two-month retrospective descriptive and observational study for analyzed records in Clinical Units equipped by electronic prescription. All in-patients who had at least one allergy record registered in the hospital computer application were included in the study. The percentage of allergies registered in hospital, primary care or both applications was quantified. Results: 723 patients were included, among whom 1,280 allergies were recorded. The allergy ratio per patient was 1.77. The average age was 62±37 years and 58.37% were women. 80.47% of the recorded allergies were drug-related. 42.11% of global allergies were registered in both applications. 21.20% of non-drug-related allergies and 47.18% of drug-related allergies were registered in both applications. According to the total of drug allergies detected in the study, 68.08% were registered in primary care and 79.13% in hospital care. Regarding to the total of non-drug-related allergies, 37.20% were registered in primary care and 84% in hospital care. Conclusions: Our study reported a high variability in the allergy registration between the different levels of the care health system. Less than the half of allergy cases are registered in both care levels studied.

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          Epidemiology and risk factors for drug allergy.

          The aim of this review was to describe the current evidence-based knowledge of the epidemiology, prevalence, incidence, risk factors and genetic associations of drug allergy. Articles published between 1966 and 2010 were identified in MEDLINE using the key words adult, adverse drug reaction reporting systems, age factors, anaphylactoid, anaphylaxis, anaesthetics, antibiotics, child, drug allergy, drug eruptions, ethnic groups, hypersensitivity, neuromuscular depolarizing agents, neuromuscular nondepolarizing agents, sex factors, Stevens Johnson syndrome and toxic epidermal necrolysis. Additional studies were identified from article reference lists. Relevant, peer-reviewed original research articles, case series and reviews were considered for review. Current epidemiological studies on adverse drug reactions (ADRs) have used different definitions for ADR-related terminology, often do not differentiate immunologically and non-immunologically mediated drug hypersensitivity, study different study populations (different ethnicities, inpatients or outpatients, adults or children), utilize different methodologies (spontaneous vs. non-spontaneous reporting, cohort vs. case-control studies), different methods of assessing drug imputability and different methods of data analyses. Potentially life-threatening severe cutaneous adverse reactions (SCAR) are associated with a high risk of morbidity and mortality. HLA associations for SCAR associated with allopurinol, carbamazepine and abacavir have been reported with the potential for clinical use in screening prior to prescription. Identification of risk factors for drug allergy and appropriate genetic screening of at-risk ethnic groups may improve the outcomes of drug-specific SCAR. Research and collaboration are necessary for the generation of clinically-relevant, translational pharmacoepidemiological and pharmacogenomic knowledge, and success of health outcomes research and policies on drug allergies. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.
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            Epidemiology of hypersensitivity drug reactions.

            Hypersensitivity drug reactions are but one of the many different types of adverse drug reactions. They may be potentially life-threatening, prolong hospitalization, affect drug prescribing patterns of physicians and result in socioeconomic costs. This review summarizes current knowledge on the incidence, prevalence, mortality and risk factors for these reactions in different populations. Hypersensitivity reactions represent about one third of all adverse drug reactions. Adverse drug reactions affect 10-20% of hospitalized patients and more than 7% of the general population. Severe reactions including anaphylaxis, drug hypersensitivity syndromes, Stevens Johnson syndrome and toxic epidermal necrolysis are also associated with significant morbidity and mortality. Although several risk factors have been identified, their clinical importance has not been fully understood. Future progress in immunogenetics and pharmacogenetics may help identify populations at risk for specific types of reactions. Well designed epidemiological studies on hypersensitivity drug reactions are lacking as most studies have been on adverse drug reactions. Such studies will be helpful in identifying patients at risk of developing such reactions, in particular severe reactions, and implementing early preventive measures.
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              Drug allergy

              Drug allergy encompasses a spectrum of immunologically-mediated hypersensitivity reactions with varying mechanisms and clinical presentations. This type of adverse drug reaction not only affects patient quality of life, but may also lead to delayed treatment, unnecessary investigations, and even mortality. Given the myriad of symptoms associated with the condition, diagnosis is often challenging. Therefore, referral to an allergist experienced in the identification, diagnosis and management of drug allergy is recommended if a drug-induced allergic reaction is suspected. Diagnosis relies on a careful history and physical examination and, in some instances, skin testing and graded challenges. Induction of drug tolerance procedures may also be required. The most effective strategy for the management of drug allergy is avoidance or discontinuation of the offending drug. When available, alternative medications with unrelated chemical structures should be substituted. Cross-reactivity among drugs should be taken into consideration when choosing alternative agents. Additional therapy for drug hypersensitivity reactions is largely supportive and may include topical corticosteroids, oral antihistamines and, in severe cases, systemic corticosteroids. In the event of anaphylaxis, the treatment of choice is injectable epinephrine. If a particular drug to which the patient is allergic is indicated and there is no suitable alternative, induction of drug tolerance procedures may be considered to induce temporary tolerance to the drug. This article provides a background on drug allergy and strategies for the diagnosis and management of some of the most common drug-induced allergic reactions, such as penicillin, sulfonamides, cephalosporins, radiocontrast media, local anesthetics, general anesthetics, acetylsalicylic acid and non-steroidal anti-inflammatory drugs, and therapeutic monoclonal antibodies.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                2021
                : 31
                : 2
                : 139-142
                Affiliations
                [1] Madrid orgnameHospital Universitario 12 de Octubre orgdiv1Servicio de Farmacia España
                Article
                S1699-714X2021000200139 S1699-714X(21)03100200139
                10.4321/s1699-714x2021000200005
                da31dca2-8eea-4930-baac-21d794f40c22

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 10 March 2020
                : 13 February 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 4
                Product

                SciELO Spain

                Categories
                Originales

                integración de sistemas,atención hospitalaria,atención primaria,Hypersensitivity,electronic prescribing,systems' integration,hospital care,primary care,Hipersensibilidad,prescripción electrónica

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