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. 2021 Feb;9(2):906-912.
doi: 10.1016/j.jaip.2020.09.027. Epub 2020 Oct 1.

Vancomycin Hypersensitivity Reactions Documented in Electronic Health Records

Santiago Alvarez-Arango  1 , Sharmitha Yerneni  2 , Olive Tang  3 , Li Zhou  4 , Christian M Mancini  5 , Suzanne V Blackley  6 , Corinne Allison Keet  7 , Kimberly G Blumenthal  8
Affiliations

Vancomycin Hypersensitivity Reactions Documented in Electronic Health Records

Santiago Alvarez-Arango et al. J Allergy Clin Immunol Pract. 2021 Feb.

Abstract

Background: Vancomycin, the most common antimicrobial used in US hospitals, can cause diverse adverse reactions, including hypersensitivity reactions (HSRs). Yet, little is known about vancomycin reactions documented in electronic health records.

Objective: To describe vancomycin HSR epidemiology from electronic health record allergy data.

Methods: This was a cross-sectional study of patients with 1 or more encounter from 2017 to 2019 and an electronic health record vancomycin drug allergy label (DAL) in 2 US health care systems. We determined prevalence and trends of vancomycin DALs and assessed active DALs by HSR phenotype determined from structured (coded) and unstructured (free-text) data using natural language processing. We investigated demographic associations with documentation of vancomycin red man syndrome (RMS).

Results: Among 4,490,618 patients, 14,426 (0.3%) had a vancomycin DAL with 18,761 documented reactions (2,248 [12.0%] free-text). Quarterly mean vancomycin DALs added were 253 ± 12 and deleted were 12 ± 2. Of 18,761 vancomycin HSRs, 7,903 (42.1%) were immediate phenotypes and 3,881 (20.7%) were delayed phenotypes. Common HSRs were rash (32% of HSRs) and RMS (16% of HSRs). Anaphylaxis was coded in 6% cases of HSRs. Drug reaction eosinophilia and systemic symptoms syndrome was the most common coded vancomycin severe cutaneous adverse reaction. RMS documentation was more likely for males (odds ratio, 1.30; 95% CI, 1.17-1.44) and less likely for blacks (odds ratio, 0.59; 95% CI, 0.47-0.75).

Conclusions: Vancomycin causes diverse adverse reactions, including common (eg, RMS) and severe (eg, drug reaction eosinophilia and systemic symptoms syndrome) reactions entered as DAL free-text. Anaphylaxis comprised 6% of documented vancomycin HSRs, although true vancomycin IgE-mediated reactions are exceedingly rare. Improving vancomycin DAL documentation requires more coded entry options, including a coded entry for RMS.

Keywords: Allergy; Drug allergy label; Drug reaction eosinophilia and systemic symptoms syndrome; Electronic health record; Epidemiology; Hypersensitivity; Infusion reaction; Phenotype; Red man syndrome; Vancomycin.

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Figures

Figure 1
Figure 1
Medical Text Extraction, Reasoning, and Mapping System (MTERMS) components used to extract vancomycin reactions including value set terms to identify “red man syndrome” (RMS) from unstructured (free-text) data. *MTERMS lexicon includes terms from standard terminologies (e.g., UMLS, RxNorm, and SNOMED CT).,,
Figure 2
Figure 2
Vancomycin drug allergy label (DAL) entries (•) and deletions (○) between April 2017 and December 2019. First quarter (January to March 2017) was not included because of transition to a different EHR system. Values are given as mean and vertical bars display the standard deviation.
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