Allergy to Drugs and Biological Agents

• Adverse drug reactions (ADR) may affect up to 1/10 of the world’s population and affect up to 20% of all hospitalized patients. 

• More than 10% of all ADR are unpredictable drug hypersensitivity reactions (DHR). 

• Both under-diagnosis and over-diagnosis are common. 

• The most common DHR involve antibiotics such as penicillins, cephalosporins, and sulfonamides, and aspirin and other non steroidal anti-inflammatory drugs.

• The clinical spectrum of DHR involves various organs, timing and severity. 

• DHR can be severe, even life threatening, and are associated with significant mortality rates. Drugs may be responsible for up to 20% of fatalities due to anaphylaxis. 

• DHR have a significant socio-economic impact on both direct costs (management of reactions and hospitalizations) and indirect costs (missed work/school days; alternative drugs). 

• Diagnostic procedures for DHR should also attempt to identify the underlying mechanisms causing the DHR. 

• Diagnosis is critical for DHR management and prevention. Selection of an alternative drug and desensitization is necessary in some cases

Insect Allergy 

• Hymenoptera venom allergy (HVA) is a common global medical problem and refers to subjects who have a sting-induced large local (LL) or systemic allergic reaction (anaphylaxis). A LL reaction is defined as a reaction larger than 10 cm in diameter which lasts over 24 hours in which the signs and symptoms are confined to tissues contiguous with the sting site. Systemic reactions cause generalized signs and symptoms and include a spectrum of manifestations, ranging from mild to life-threatening. Mild systemic reactions may be limited only to the skin and consist of flushing, urticaria, and angioedema. More severe systemic reactions can involve bronchospasm, laryngeal edema, and hypotension. HVA can cause fatal anaphylaxis. 

• The morbidity rate is underestimated; fatal reactions may not be appropriately recorded, accounting for this underestimation. 

• The incidence of positive specific IgE antibodies to venom is high in the general population, but only a fraction of such individuals develop a systemic reaction. 

• Fatal reactions occur in up to 50% of individuals who have no documented history of a previous systemic reaction. 

• HVA impairs long-term quality of life (QOL) and is the cause of substantial socio-economic problems. 

• A subject’s QOL is negatively affected when appropriate diagnosis and education are not achieved and when venom immunotherapy (VIT) (a series of injections of the venom to which the subject is allergic and which essentially cures their disease) is not utilized. 

• HVA can be effectively treated with VIT and appropriate venom therapies.

• HVA poses a problem in occupational settings, especially in bee keepers and greenhouse workers. 

• HVA has important adverse consequences in terms of employment, earning capacity and leisure and sporting activities. 

• HVA has a substantial adverse financial impact on healthcare costs.

Occupational Allergy 

• Occupational allergic diseases represent an important public health issue due to their high prevalence and their socio-economic burden. 

• Occupational asthma (OA) contributes significantly to the global burden of asthma, since the condition accounts for approximately 15% of asthma amongst adults. 

• Allergic contact dermatitis (ACD) is one of the most common occupational diseases. 

• Occupational allergic diseases remain largely underrecognized by physicians, patients, and occupational health policy makers. 

• Occupational allergic diseases can result in long-term health impairment, especially when the diagnostic and avoidance measures are delayed. 

• Occupational allergic diseases lead to important adverse consequences in terms of healthcare resources, employment, earning capacity and quality of life. 

• Occupational allergic diseases are associated with a substantial adverse financial impact for affected workers, insurance or compensation schemes, health services, and employers. 

• Occupational allergic diseases are, by definition, preventable diseases and their burden should be minimized by appropriate preventative strategies.