The most frequent cause of drug anaphylaxis in Russia was antibiotics

Russian scientists analyzed the Pharmacovigilance database and found that most often anaphylaxis in the period from 2019 to 2023 was provoked by antibacterial drugs for systemic use, local anesthetics and cyclooxygenase inhibitors. 9.5 percent of drug anaphylaxis cases were fatal. Pediatric cases accounted for 5.8 percent of anaphylaxis. The report is published in the journal Pharmaceuticals.

Anaphylaxis is defined as one of the most severe forms of allergy in which respiration and circulation are impaired. The prevalence of severe allergic reactions, including anaphylaxis, is increasing worldwide. The most common allergens are considered to be food, insect venoms and drugs, the latter of which can affect up to a third of patients in emergency departments. Also, meta-analyses show that the occurrence of drug allergy in the population is 8.3 percent. Small retrospective studies on national samples show that antibacterial drugs and cyclooxygenase (COX) inhibitors are the most frequent cause of severe reactions.

A team of Russian scientists led by Olga Butranova of RUDN used an analysis of the national pharmacovigilance database to estimate the proportion of drug-induced anaphylaxis cases among all drug-induced allergy cases for the period from April 2, 2019 to June 21, 2023. The researchers found a total of 2,727 drug allergy cases in the electronic database. Of these, 8.3 percent of the cases were anaphylaxis. The mean age of these patients was 48.2 ± 15.8 years. Death occurred in 9.46 percent of drug anaphylaxis cases.

Researchers estimated that seven major pharmacologic groups were responsible for most cases of anaphylaxis development: Antibacterial drugs for systemic use (44.6 percent), local anesthetics (20 percent), cyclooxygenase inhibitors (10 percent), iodine-containing contrast agents (6.6 percent), cardiovascular drugs (6.2 percent), drugs acting on the central nervous system (1.5 percent), and neuromuscular blockers (1.4 percent). Other medications accounted for 9.5 percent.

Administration of beta-lactam antibiotics was most often responsible for the development of anaphylaxis among all antibacterial drugs, and ceftriaxone was responsible for 63.3 percent of anaphylaxis cases. Among the local anesthetics, lidocaine was the most frequent cause of anaphylaxis (63.7 percent), and 29 cases ended in death. In 49 cases, paracetamol administration led to the development of anaphylaxis. Methamizole came second in this group. When the fatal cases of drug anaphylaxis were evaluated, it was found that the leading drug groups were antibacterial drugs, local anesthetics and cardiovascular drugs.

Researchers found 3,443 cases of drug allergy among children, where drug anaphylaxis accounted for 3.9 percent and among all drug anaphylaxis cases, children accounted for 5.8 percent. In this cohort, the mean age was 11.8 ± 4.5 years (minimum one day, maximum 18 years), and death occurred in 12.8 percent of anaphylaxis cases.

The most common drug groups that caused anaphylaxis in children were antibiotics, local anesthetics, and COX inhibitors. Fatalities due to antibiotics were reported in eight cases. Another 3,307 cases of drug allergies were reported in patients over 65 years of age, with anaphylaxis due to drugs accounting for two percent. The most common drug groups were antibiotics, cardiovascular drugs iodine-containing contrast agents.

The results of this analysis show the pattern of drug allergy in Russia over the past five years. These data may help in the development of interventions aimed at preventing drug allergies.