Drug intolerance: age-related aspects

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Abstract

BACKGROUND: Drug hypersensitivity is an adverse reaction caused by immune or non-immune mechanisms to the intake of adequate doses of drugs. To avoid a dangerous situation, correctly collected pharmacological history, taking into account all the characteristics of the patient (gender, age, concomitant pathology), and knowledge of the mechanism of action of drugs can help a practicing physician who does not currently have a reliable method for diagnosing drug hypersensitivity.

AIM: Identification of age-specific drug intolerance.

MATERIALS AND METHODS: The study was conducted from 2017 to 2020 and included 200 outpatient medical history forms of individuals diagnosed with an unspecified pathological reaction to a drug or medication. All drug reactions were based on patient’s own statements and were allocated as dichotomous variables. The results were analyzed by nonparametric statistics (Pearson’s chi-square).

RESULTS: Three groups of patients were identified: 18–44 years (n=49), 45–60 years (n=60), ≥61 (n=91). The odds of incomprehensible reactions were 2.2 times higher in patients in group 3 than in patients in the other groups. Group 3 patients were 12 times more likely to have an itchy reaction to medications than patients in the other groups. Group 1 patients were 3 times more likely to have urticaria than patients in groups 2 and 3. The odds of drug intolerance to angiotensin-converting enzyme (ACE) inhibitors were 2.6 times higher in patients in group 3 than in patients in the other groups. When comparing clinical manifestations of drug intolerance to penicillin and cephalosporin antibiotics, no significant differences were found in all patients. The presence of allergies and somatic pathology of ≥3 systems did not significantly affect the possibility of reactions of varying severity to ≥3 drugs in these groups.

CONCLUSIONS: Patient’s age has no effect on the possibility of reactions to certain groups of drugs. The exception was ACE inhibitors, which is most likely due to the higher frequency of prescribing antihypertensive therapy in patients in this age group. The aggravation of clinical manifestations and the occurrence of polypharmacy are not associated with age and comorbid background. Age and non-life-threatening clinical manifestations of drug intolerance were correlated, which indicates the absence of the reliable effect of age on the possibility of anaphylactic shock or angioedema.

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About the authors

Maria A. Grakhova

Regional Clinical Hospital No 1

Author for correspondence.
Email: mari.grahova@yandex.ru
ORCID iD: 0000-0002-1657-0695
SPIN-code: 3567-8379
Scopus Author ID: 57204454570
Mendeley Profile: https://www.mendeley.com/impact/maria-grakhova/

MD

Russian Federation, 55 Kotovskogo, Tyumen, 625023

Olga A. Rychkova

Tyumen State Medical University

Email: richkovaoa@mail.ri
ORCID iD: 0000-0002-2566-5370
SPIN-code: 1382-1555

MD, Dr. Sci. (Med.), ProfessorТюменский государственный медицинский университет

Russian Federation, Tyumen

Anastasia V. Braun

INVITRO-Ural LLC

Email: badulina_anastasiya@mail.ru
ORCID iD: 0000-0002-5909-2048
SPIN-code: 8332-6947

MD

Russian Federation, Tyumen

Almira S. Sagitova

Tyumen State Medical University

Email: ya.al.sagitowa@yandex.ru
ORCID iD: 0000-0002-6741-8458
SPIN-code: 8210-5726

MD, Cand. Sci. (Med.)

Russian Federation, Tyumen

Maria A. Nesterova

Tyumen Region Infection Pathology Research Institute

Email: maria.nesterova72@yandex.ru
ORCID iD: 0000-0002-0668-6213
SPIN-code: 2103-4460

MD

Russian Federation, Tyumen

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Supplementary files

Supplementary Files
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1. Fig. 1. Study design diagram.

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2. Fig. 2. Clinical manifestations of drug intolerance in all patients. Note: * p <0.05 if data of the 1st group were compared with two other groups; ** p <0.05 if data of the 3rd group were compared with two other groups; АФШ ― anaphylactic shock. This diagram did not include a cough response to ACE inhibitors.

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3. Fig. 3. Structure of the most frequently encountered groups of drugs in the whole sample, which caused hypersensitivity reactions. Note: НПВС ― non-steroidal anti-inflammatory drugs; иАПФ ― angiotensin converting enzyme inhibitors.

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4. Fig. 4. Structure of clinical manifestations of drug intolerance to angiotensin-converting enzyme inhibitors in all groups.

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5. Fig. 5. Structure of clinical manifestations of drug intolerance to angiotensin-converting enzyme inhibitors in three age groups.

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6. Fig. 6. The overall structure of clinical manifestations of drug reactions. Note: АФШ ― anaphylactic shock. This diagram does not include cough on angiotensin-converting enzyme inhibitors.

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