Every year, around 62,000 people in England have a serious allergic reaction to a drug which puts them in hospital, and in many cases, they had been given a drug to which they were already known to be allergic, say officials.
New guidelines from the National Institute for Health and Care Excellence (NICE) encourage all healthcare professionals to be alert to the possibility of drug allergies and offer best practice on clinical management to ensure every individual is spared serious harm.
Their recommendations prioritise the thorough assessment of any person who is suspected of having a drug allergy and detail what signs to look out for. These include symptoms that come on rapidly such as hives, wheezing, redness or swelling of the skin, and symptoms which can take several days to show such as fever, liver dysfunction or eczema.
All drugs have the potential to cause side effects but not all of these are considered to be allergic. An allergic reaction occurs when the body thinks the medicine is a threat and the immune system responds to it. The drugs often linked to immune responses include commonly-used treatments such as antibiotics, general anaesthesia and painkillers such as aspirin and ibuprofen.
“About half a million people admitted into NHS hospitals each year will have a diagnosed drug allergy. If we know that giving someone a particular drug could cause them harm, or in the worst instances may even kill them, the utmost care must be taken to ensure they are not prescribed or administered that drug,” said Mark Baker, director of the centre for clinical practice at NICE.
The guideline identifies major issues in clinical documentation of drug allergy, with insufficient information being recorded and shared with other healthcare professionals or people with allergies themselves. It also recommends that prescriptions, either paper or electronic and issued in any setting, should include information on drugs or drug classes which people with a known allergy should avoid.
Insufficient awareness of available services can cause considerable differences in how drug allergies are managed and access to treatment across the country, the guidelines note. The recommendations describe when people can have non-specialist treatment, for instance considering a different drug from the same class in those who have had a mild allergic reaction. And they highlight the importance of referring people who have had severe reactions or need ongoing treatment, to find out what alternatives can be taken safely.
The guidelines have been welcomed by Allergy UK, whose clinical director, Maureen Jenkins, said the charity frequently receives calls about the lack of awareness about drug allergy, inadequate documentation and communication between health professionals, and that this can put patients’ lives at risk.
NICE’s new guidelines “will lay the foundation stone for better understanding and management of drug allergy across primary, secondary and tertiary care,” she said.