Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 16:3:953117.
doi: 10.3389/falgy.2022.953117. eCollection 2022.

Prevalence and impact of misdiagnosed drug allergy labels among patients with hereditary angioedema

Jane Chi Yan Wong  1 , Noel Cheong  1 , Chak Sing Lau  1 , Philip Hei Li  1
Affiliations

Prevalence and impact of misdiagnosed drug allergy labels among patients with hereditary angioedema

Jane Chi Yan Wong et al. Front Allergy. .

Abstract

Introduction: Hereditary angioedema (HAE) is a rare condition with presents with episodic attacks of angioedema, which is often misdiagnosed as allergy, and associated with significant morbidity and mortality. Misdiagnosed drug allergy (DA) labels are also associated with a multitude of adverse clinical outcomes. However, the prevalence and impact of incorrect DA labels on HAE remains unknown.

Methods: Data from the clinical records of all HAE patients in Hong Kong were collected and analysed. All HAE patients with DA labels on their medical records were recruited to proceed with DA testing, including confirmatory drug provocation tests (DPT).

Results: Nine (22%) out of a total of 41 HAE patients carried at least one DA label. Five of nine (56%) patients had more than 1 DA label and there was a total number of 16 DA labels. The most common DA label was to beta-lactams (37.5%). Presence of DA label was associated with delay in HAE diagnosis (23.8 ± 11.1 vs. 10.2 ± 14.3 years, p = 0.012), likelihood of HAE attacks (100% vs. 46.9%, p = 0.005) and rate of hospitalization (3.78 ± 2.68 vs. 1.32 ± 2.61, p = 0.022) per year. All (100%) of all DA labels were disproven and removed after confirmatory DPT were performed.

Conclusion: DA labels are prevalent among HAE patients but are frequently misdiagnosed and mislabelled. Misdiagnosed DA are associated with delay in HAE diagnosis as well as adverse clinical outcomes. Immunologists/allergists should consider pre-emptively reviewing and investigate every suspicious DA label, especially among HAE patients.

Keywords: Hong Kong; drug allergy; drug delabelling; hereditary angioedema; prevalence.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Total number of days of non-beta-lactam antibiotics used by HAE patients with beta-lactam allergy label.
Figure 2
Figure 2
Allergy investigations and outcome of HAE patients with suspected drug allergy labels.
See this image and copyright information in PMC

References

    1. Busse PJ, Christiansen SC. Hereditary angioedema. N Engl J Med. (2020) 382(12):1136–48. 10.1056/NEJMra1808012 - DOI - PubMed
    1. Li PH, Wong J, Lam K, Chiang V, Au E. The First Hereditary Angioedema Registry in Hong Kong Chinese. Brussels, Belgium: 2019 Focused Meeting of the European Society for Immunodeficiencies; (2019).
    1. Zanichelli A, Longhurst HJ, Maurer M, Bouillet L, Aberer W, Fabien V, et al. Misdiagnosis trends in patients with hereditary angioedema from the real-world clinical setting. Ann Allergy Asthma Immunol. (2016) 117(4):394–8. 10.1016/j.anai.2016.08.014 - DOI - PubMed
    1. Li PH, Yeung HHF, Lau CS, Au EYL. Prevalence, incidence, and sensitization profile of beta-lactam antibiotic allergy in Hong Kong. JAMA Netw Open. (2020) 3(5):e204199. 10.1001/jamanetworkopen.2020.4199 - DOI - PMC - PubMed
    1. Li PH, Chung HY, Lau CS. Epidemiology and outcomes of geriatric and non-geriatric patients with drug allergy labels in Hong Kong. Hong Kong Med J. (2021) 27(3):192–7. 10.12809/hkmj208716 - DOI - PubMed

LinkOut - more resources