Global differences and risk factors influencing drug hypersensitivity quality of life: A multicenter, multiethnic study of drug allergy across 3 continents

Abstract

Background: Penicillin allergy labels are associated with many adverse outcomes. Fear and restriction of future medication use also have an impact on health-related quality of life (HR-QoL). However, the impact of a drug allergy on HR-QoL and its associated factors remains unknown.

Objective: We sought to investigate the impact of penicillin allergy labels and compare the factors associated with HR-QoL impairment among patients in an international multicenter, multiethnic cohort.

Methods: HR-QoL was measured using the 6-item Drug Hypersensitivity Quality of Life Questionnaire (DrHy-Q) and compared among patients labeled with penicillin allergy, before their allergy evaluation, from 8 adult allergy/immunology clinics across Asia, Australia, and North America.

Results: We recruited 643 patients labeled with penicillin allergy (median age, 56 years [interquartile range, 39-67]; male:female ratio, 1:2.2), with 273 (42.5%), 186 (28.9%), and 184 (28.6%) from Asia, North America, and Australia, respectively. The median DrHy-Q score was 8.3 (interquartile range, 0.0-29.2). All patients underwent penicillin allergy evaluation, and 96% (617 of 643) were delabeled following negative provocation test results. Female patients (8.3 vs 4.2; P = .003), those with other concomitant antimicrobial allergy labels (20.8 vs 4.2; P = .004), and patients from Asia (33.3 vs 4.2 [North America] vs 0 [Australia]; P < .001) had significantly higher DrHy-Q scores, reflecting a reduced HR-QoL. Ethnicity as well as other allergy variables were not significant in the multivariate analysis.

Conclusions: Regional differences, ethnicity, and other risk factors influence HR-QoL impairment among patients labeled with penicillin allergy. Future studies are needed to understand the contributions of regional sociodemographic factors and identify interventions to improve HR-QoL.

Keywords: Drug allergy; delabeling; health-related quality of life (HR-QoL); penicillin; quality of life.

Fig 1

A-C, 6-Item DrHy-Q scores stratified by sex (Fig 1, A), concomitant antimicrobial labels (Fig 1, B), and geographical region (Fig 1, C). ∗P < .05; ∗∗P < .01; ∗∗∗P < .001.

Fig 2

Responses to individual DrHy-Q questions stratified by sex. The scores 0 to 4 correspond to “not at all” for score 0, “slightly” for score 1, “moderately” for score 2, “very” for score 3, and “extremely” for score 4.

Fig 3

Responses to individual DrHy-Q questions stratified by presence of concomitant antimicrobial labels. The scores 0 to 4 correspond to “not at all” for score 0, “slightly” for score 1, “moderately” for score 2, “very” for score 3, and “extremely” for score 4.

Fig 4

Responses to individual DrHy-Q questions stratified by geographical region. The scores 0 to 4 correspond to “not at all” for score 0, “slightly” for score 1, “moderately” for score 2, “very” for score 3, and “extremely” for score 4.

Fig 5

6-Item DrHy-Q scores stratified by PEN-FAST scores and geographical region. The color code corresponds to PEN-FAST 0, 1, and 2 (from light orange to dark orange). No significant differences were seen in subgroup analysis of individual regions.