Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Parbir K Jagpal; Saad Alshareef; John F Marriott; Mamidipudi Thirumala Krishna

doi:10.1002/clt2.12190

Characterization, epidemiology and risk factors of multiple drug allergy syndrome and multiple drug intolerance syndrome: A systematic review

Clin Transl Allergy. 2022 Aug 22;12(8):e12190. doi: 10.1002/clt2.12190. eCollection 2022 Aug.

Authors

Parbir K Jagpal¹, Saad Alshareef², John F Marriott¹, Mamidipudi Thirumala Krishna^{2

3}

Affiliations

¹ Institute of Clinical Sciences University of Birmingham Birmingham UK.
² University Hospitals Birmingham NHS Foundation Trust Birmingham UK.
³ Institute of Immunology and Immunotherapy University of Birmingham Birmingham UK.

Abstract

Background: Multiple drug allergy and multiple drug intolerance syndrome (MDAS/MDIS) labels are an impediment to clinical care and knowledge regarding these conditions is limited. This systematic review investigated the characterization, epidemiology, risk factors, clinical impact and pharmaco-economics of MDAS and MDIS.

Methods: Systematic literature search across 11 databases (01 January 2000-06 November 2020) for MDIS, MDAS and related terminology. Studies were reviewed for quality of evidence and risk of bias by employing Critical Appraisal Skills Programme cohort study checklist. A narrative synthesis approach facilitated by systematic textual descriptions, tabulation and thematic analysis was adopted.

Results: There was heterogeneity in terminology and methodology. Few studies applied standard drug allergy diagnostic methods. There is some evidence to suggest that multiple drug hypersensitivity syndrome (MDHS; i.e., confirmed allergies in MDAS) is a distinct clinical entity. Prevalence of MDIS and MDAS labels in unselected & selected populations varied between 2.1%-6.4% & 4.9%-90% and 1.2% & 0%-36% respectively. Reported risk factors included female gender, increasing age, body mass index, anxiety, depression, co-morbidities, concurrent allergies and increased healthcare utilization. Drugs commonly implicated were antibiotics and non-steroidal anti-inflammatory drugs. No studies relating to clinical impact and pharmaco-economics were found.

Conclusion: There is considerable burden of MDAS and MDIS labels. Data needs cautious interpretation as majority of studies described involved unverified labels. Despite this limitation and heterogeneity of studies, there is some evidence to suggest that MDHS is a distinct clinical entity. Well-designed multi-centre studies applying standardized terminology and diagnostic methodology are needed to gain further insight into these conditions.

Keywords: multiple drug allergy; multiple drug allergy syndrome; multiple drug hypersensitivity; multiple drug intolerance; multiple drug intolerance syndrome.