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Overprescription of antidepressants contributes to multiple drug sensitivities


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http://www.medpagetoday.com/MeetingCoverage/AAAAIMeeting/31482 The iatrogenic condition of multiple drug intolerance is traced to polypharmacy and prior adverse events.


Treatment Often Safe in Patients with Drug 'Allergies'

By Nancy Walsh, Staff Writer, MedPage Today March 04, 2012


This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


ORLANDO -- Many cases of "multiple drug allergies" are not allergies at all, but represent intolerance resulting from exposure to numerous pharmacologic agents, particularly among certain patient populations, a researcher reported here.


Multiple drug "allergies" were identified in the electronic medical records of 2.1% of patients in a large health plan in 2009, according to Eric M. Macy, MD, from Kaiser Permanente in San Diego, and colleagues.


Patients who had been classified as having multiple drug allergies were older, at 62.4 years, women (84.9%), and had high body mass index (29.3), the researchers reported at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.


"If you are given a lot of drugs and use the healthcare system frequently, you will get drug reactions and adverse events, but you're not necessarily allergic," Macy told MedPage Today in a poster session.


Drug allergy specifically refers to an IgE-mediated sensitization to a specific medication, and any subsequent exposure can produce potentially lethal anaphylaxis.


Unfortunately, adverse reactions of various sorts often are listed in patients' medical records as allergies, which results in subsequent physician frustration because of limited therapeutic options.


To determine the prevalence and clinical characteristics of patients classified as having drug allergy, the researchers reviewed the medical records of 2.4 million enrollees in the Kaiser Permanente Southern California health plan in 2009. They patients had at least 11 months of healthcare coverage and a minimum of one healthcare visit during the year.


They found that 20% had at least one reported allergy -- 25% of women and 14% of men -- with the highest rates among antibiotics being for penicillin, sulfonamides, macrolides, and cephalosporins.


Compared with plan members whose records indicated no allergies to drugs, those with four or more reported allergies were exposed to almost six times as many drugs (40 versus 7.5).


Other comparisons between these two groups of patients (no recorded allergies versus four or more reported allergies) found these differences during the study year:

[note: This looks like an error, the list below must be the reported-allergies group vs no recorded allergies.]


Courses of antibiotics, 0.80 versus 0.27

Courses of narcotics, 0.64 versus 0.17

Courses of antidepressants, 0.11 versus 0.04

Outpatient visits, 26.6 versus 6.1

Emergency department visits, 1.5 versus 0.3

Days of hospitalization, 12.4 versus 1.1


Multiple drug intolerance is at least partly an iatrogenic condition, Macy asserted, and while it can lead to anxiety among patients, only a minority actually are at risk of a life-threatening IgE-related allergic response.


And only a fraction of cases involved the more common typical urticarial syndromes.


"In many cases, if a patient with a recorded 'drug allergy' needs a specific drug, you will be able to use it and there will be low rates of serious morbidity," he said.


Drug challenges and hypersensitivity testing are suitable for many patients in this situation, and in the future coordinated efforts should be made to limit polypharmacy in the older population with the goal of reducing iatrogenic drug intolerance.



One caution is that individuals who have previously had a serious toxic reaction, such as drug-related Stevens-Johnson syndrome, should not be rechallenged, he noted.


The investigators had no financial disclosures.


Primary source: American Academy of Allergy, Asthma, and Immunology

Source reference:

Macy E, et al "Multiple drug intolerance syndrome: prevalence, clinical characteristics, and management" AAAAI 2012; Abstract 377.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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"Drug challenges and hypersensitivity testing are suitable for many patients in this situation, and in the future coordinated efforts should be made to limit polypharmacy in the older population with the goal of reducing iatrogenic drug intolerance."


I've wondered how geriatrics will handle all of the people who have been on psychotropics from a young age.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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They will put them in a tube in their stomach no doubt

Effexor XL 2009-2012. CT 150mg Effexor XR  2012, Effexor XR  75mg  2012  then rapid taper to 0, Reinstated Effexor XR 13mg then updosed to 20mg, Tapered to 18mg Effexor XR 4/9/12, Off Effexor XL ?Reinstated  Effexor XL 150 mgs  August  2012, Crashed in November 2012, Prozac 40 mgs 2012 to Feb 2018, Buspar 60  mgs 2012-stopped 2015, Remeron 7.5 mgs as needed for sleep-stopped Feb 2017, Prozac 50 mgs Feb 2018 to March 2018, Lexapro 5 mgs March 18 2018 to May 17th 2018, Lexapro 2.5 mgs  May 18th to May 26th 2018, Prozac 10 mgs May 15th 2018, Prozac 5 mgs May 19th 2018 to current day May 28th 2018,  Xanax 0.25 mgs to 0.5 mgs daily for over 15 years. Increased Xanax to 1.5 mgs Sept 2012, Tapered Xanax to 0 mgs  May 2013.Reinstated Xanax Feb 2017 at 0.125 mgs as needed, Gradual increase of Xanax to 1.5 mgs daily till May 22nd 2018, Xanax 1.25 mgs daily. Holding


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