Disproportionate drug allergy labelling among middle-aged patients and
barriers to excipient allergy testing from the Hong Kong Comprehensive
Excipient and Drug Allergy Registry (CEDAR)
Abstract
Background: Longitudinal whole-population studies can explore new
dimensions in drug allergy research. Excipient allergy testing remains a
barrier to allergy evaluation in countries without legislations
mandating ingredient disclosure in registered drugs. The Comprehensive
Excipient and Drug Allergy Registry (CEDAR) was established to
investigate Hong Kong’s drug allergy landscape and potential role of
excipient registries. Methods: Drug allergy data from over 7,337,778
individuals between 2016-2021 was analyzed. Excipient lists were
gathered from all formulations of the top 50 reported drug allergies and
checked for the presence of polyethylene glycol (PEG). Results: The
absolute-prevalence and -incidence of reported drug allergy was 5.61%
and 277/100,000 population in 2021, respectively. Annual incidence of
newly reported drug allergy was stable between 2016-2019, until a
significant drop in 2020 (-16.3%, p=0.037). The most common implicated
drugs were anti-infectives (245,832 [44.5%]), NSAIDs (106,843
[19.3%]), and nervous system drugs (45,802 [8.3%]). There was
significant higher incidence among individuals aged >40,
contributing to the majority of newly reported allergies (377,004,
68.2%). Beta-lactams and nervous system drugs were the most common
reported culprits of anaphylaxis and Stevens-Johnson syndrome. CEDAR was
unable to confirm presence or absence of PEG in any of the top reported
culprits due to insufficient excipient information. Conclusion: We
report the detailed drug allergy landscape of the Hong Kong population.
Excipient registries are ineffective in countries without mandatory
excipient listings . Contrary to traditional doagma, we identified a
disproportionately higher incident drug allergy among middle-aged and
older patients. Findings need to be confirmed by region-specific big
data studies.