Asia Pac Allergy.  2016 Apr;6(2):105-111. 10.5415/apallergy.2016.6.2.105.

Knowledge, attitudes, and practices survey of drug allergy among healthcare practitioners in central China: a multicenter study

• Wang Y
• Zhu R
• Huang N
• Li W
• Yang L
• Zhang S
• Liu G

• KMID: 2396979
• DOI: http://doi.org/10.5415/apallergy.2016.6.2.105

Abstract

BACKGROUND
Drug allergy (DA) is one of the most important contributors to iatrogenic morbidity and mortality. Currently DA remains a major challenge for healthcare practitioners (HCPs).
OBJECTIVE
To assess the knowledge, attitudes and practices of DA among HCPs in Central China.
METHODS
A 25-item self-administered DA questionnaire were developed and applied in our study. The questionnaire covered 3 domains: knowledge, attitudes, and practice patterns. From July 2015 to October 2015, HCPs in 7 cities of Central China anonymously participated in the cross-sectional study.
RESULTS
A total of 350 HCPs participated the study, 91 questionnaires uncompleted and 259 were analyzed. Among the respondents, 166 (64.1%) were doctors, 55 (21.2%) were nurses and 38 (14.7%) were medical students. The mean knowledge precision was 59.8%. HCPs agreed that drug induced immediate allergic reactions were IgE mediated (83.4%) and happened within 6 hours after drug administration (89.6%), and epinephrine was the first choice for drug induced anaphylaxis (79.5%). They also agreed that penicillin skin test was valuable to predict allergic reaction (88.4%). However, high proportion of HCPs (66.0%) believed glucocorticoids had an impact on drug skin test rather than antihistamines (4.2%), 47.1% never performed positive and negative control during skin test. More than 90% of the respondents would take patients' allergic history before drug administration, 98.8% agreed that they should receive advanced training of DA knowledge and practice.
CONCLUSION
The HCPs demonstrated a low level of knowledge regarding DA. Advanced education is urgently needed for better understanding and filling the gaps exist in knowledge and clinical practice of DA.

Keyword

Knowledge; Attitude; Practice, Drug allergy, Healthcare practitioner

MeSH Terms

Anaphylaxis
Anonyms and Pseudonyms
China*
Cross-Sectional Studies
Delivery of Health Care*
Drug Hypersensitivity*
Education
Epinephrine
Glucocorticoids
Histamine Antagonists
Humans
Hypersensitivity
Immunoglobulin E
Mortality
Penicillins
Skin Tests
Students, Medical
Surveys and Questionnaires
Epinephrine
Glucocorticoids
Histamine Antagonists
Immunoglobulin E
Penicillins

Reference

1. Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, Khan DA, Lang DM, Park HS, Pichler W, Sanchez-Borges M, Shiohara T, Thong BY. International Consensus on drug allergy. Allergy. 2014; 69:420–437.

2. Demoly P, Pichler W, Pirmohamed M, Romano A. Important questions in allergy: 1--drug allergy/hypersensitivity. Allergy. 2008; 63:616–619.

3. Gomes E, Cardoso MF, Praca F, Gomes L, Marino E, Demoly P. Self-reported drug allergy in a general adult Portuguese population. Clin Exp Allergy. 2004; 34:1597–1601.

4. Mittmann N, Knowles SR, Gomez M, Fish JS, Cartotto R, Shear NH. Evaluation of the extent of under-reporting of serious adverse drug reactions: the case of toxic epidermal necrolysis. Drug Saf. 2004; 27:477–487.

5. Mirakian R, Ewan PW, Durham SR, Youlten LJ, Dugue P, Friedmann PS, English JS, Huber PA, Nasser SM. BSACI. BSACI guidelines for the management of drug allergy. Clin Exp Allergy. 2009; 39:43–61.

6. Scherer K, Bircher AJ. Danger signs in drug hypersensitivity. Med Clin North Am. 2010; 94:681–689.

7. Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, Campi P, Sanz ML, Castells M, Demoly P, Pichler WJ. European Network of Drug Allergy and the EAACI interest group on drug hypersensitivity. General considerations on rapid desensitization for drug hypersensitivity: a consensus statement. Allergy. 2010; 65:1357–1366.

8. Mertes PM, Malinovsky JM, Jouffroy L, Aberer W, Terreehorst I, Brockow K, Demoly P. Working Group of the SFAR and SFA. ENDA. EAACI Interest Group on Drug Allergy. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011; 21:442–453.

9. Li LF, Ma C. Epidemiological study of severe cutaneous adverse drug reactions in a city district of China. Clin Exp Dermatol. 2006; 31:642–647.

10. Li W, Zhu LL, Zhou Q. Safe medication use based on knowledge of information about contraindications concerning cross allergy and comprehensive clinical intervention. Ther Clin Risk Manag. 2013; 9:65–72.

11. Schultz LJ, Ettling M, Chitsulo L, Steketee RW, Nyasulu Y, Macheso A, Nwanyanwu OC. A nation-wide malaria knowledge, attitudes and practices survey in Malawi: objectives and methodology. Trop Med Parasitol. 1994; 45:54–56.

12. Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol. 2005; 5:309–316.

13. Tang R, Xu HY, Cao J, Chen S, Sun JL, Hu H, Li HC, Diao Y, Li Z. Clinical Characteristics of Inpatients with Anaphylaxis in China. Biomed Res Int. 2015; 2015:429534.

14. Limsuwan T, Demoly P. Acute symptoms of drug hypersensitivity (urticaria, angioedema, anaphylaxis, anaphylactic shock). Med Clin North Am. 2010; 94:691–710.

15. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, Brockow K, Pichler WJ, Demoly P. European Network for Drug Allergy (ENDA). EAACI interest group on drug hypersensitivity. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003; 58:854–863.

16. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I. ENDA/EAACI Drug Allergy Interest Group. Skin test concentrations for systemically administered drugs: an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013; 68:702–712.

17. Simons FE, Ardusso LR, Bilò MB, Dimov V, Ebisawa M, El-Gamal YM, Ledford DK, Lockey RF, Ring J, Sanchez-Borges M, Senna GE, Sheikh A, Thong BY, Worm M. World Allergy Organization. 2012 Update: World Allergy Organization Guidelines for the assessment and management of anaphylaxis. Curr Opin Allergy Clin Immunol. 2012; 12:389–399.

18. Simons FE, Ardusso LR, Bilo MB, El-Gamal YM, Ledford DK, Ring J, Sanchez-Borges M, Senna GE, Sheikh A, Thong BY. World Allergy Organization. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol. 2011; 127:587–593.e1-22.

19. Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002; 57:45–51.

20. Bousquet PJ, Gaeta F, Bousquet-Rouanet L, Lefrant JY, Demoly P, Romano A. Provocation tests in diagnosing drug hypersensitivity. Curr Pharm Des. 2008; 14:2792–2802.

21. Wei X, Xie Y, Wang Y. Skin test: guide of post-marketed re-evaluation of clinical safety in traditional Chinese medicine injection. Zhongguo Zhong Yao Za Zhi. 2011; 36:2877–2879.

22. Grossman SL, Baumann BM, Garcia Peña BM, Linares MY, Greenberg B, Hernandez-Trujillo VP. Anaphylaxis knowledge and practice preferences of pediatric emergency medicine physicians: a national survey. J Pediatr. 2013; 163:841–846.