Evaluating pharmacists' knowledge, attitude, and practices toward amiodarone cross-reactivity with iodine: a cross-sectional pilot study

Abstract

Introduction: Iodine is a vital mineral of the human body that acts by maintaining the health of the thyroid gland. Research has shown that iodine-rich food allergy (i.e., seafood allergy) is not caused by iodine itself; instead, it is caused by other proteins including tropomyosin and parvalbumin in shellfish and fish, respectively. Amiodarone is a commonly used antiarrhythmic agent containing a significant amount of iodine.

Objective: This study's objective was to assess pharmacists' knowledge, attitude, and practices toward the misconception of iodine allergy and the cross-reactivity with amiodarone.

Methods: In February 2020, a cross-sectional study was conducted by sending out an online survey to three pharmaceutical organizations (Saudi Pharmaceutical Society, Kuwait Pharmaceutical Association, and Oman Pharmaceutical Society). Additionally, an electronic questionnaire was administered to pharmacists attending the Dubai International Pharmaceuticals and Technologies Conference and Exhibition 2020 (DUPHAT). Chi-square or Fisher's exact test, when appropriate, were used to compare categorical variables. The statistical analyses were carried out using SPSS software.

Results: Data were collected from 66 respondents. However, only 61 (92.4%) were included in the final analysis following the exclusion of incomplete responses. The mean age of participants was 35 ± 8.48 years. The majority of participants did not have the Board of Pharmacy Specialties Certification (54.1%). Moreover, (41%) of participants licensed as pharmacists with more than 10 years of initial pharmacy licensure. Forty-three (70.5%) of participants had the misconception that iodine allergy should be considered before amiodarone administration, 20/32 (62.5%) of whom considered iodine allergy alone thought that premedication with corticosteroids and/or antihistamines is necessary. Concerning iodine allergy and amiodarone use, there was no significant difference in knowledge between the pharmacists who have board certification and those who did not.

Conclusion: Pharmacists' misconception concerning iodine allergy and cross-reactivity with amiodarone was evident. Implementation of educational programs targeting pharmacists is necessary to correct these misconceptions.

Keywords: Amiodarone; Hypersensitivity; Iodine allergy; Pharmacist; Radiocontrast media allergy; Shellfish allergy.

Figure 1. Sample collection with number of completed responses.

Figure 2. The following allergies should be considered prior to amiodarone use.

Figure 3. Do you recommend premedication with corticosteroids and/or antihistamines prior to amiodarone initiation in these patients with known allergies?

Figure 4. Which of the following allergies do you think should be in your pharmacy computer system and/or electronic medical record?

Figure 5. The influence of Board of Pharmacy Specialties Certification on pharmacists’ perspective of considering iodine allergy prior to amiodarone use.