Cofactors of drug hypersensitivity—A monocenter retrospective analysis

BACKGROUND: Drug hypersensitivity reactions (DHRs) are major medical problems that influence the treatment of patients by both under- and overdiagnosis. Still, little is known about the role of predisposing or protecting cofactors of DHR. OBJECTIVE: This study aims to determine drug-specific cofactors in patients with DHR. METHODS: Retrospective file chart analysis of inpatients with suspected DHR in our department between 2015 and 2020 was performed. Descriptive statistics and multiple logistic regression were conducted for the estimation and statistical interference. RESULTS: DHRs were suspected in 393 patients with 678 culprit drugs. In 183 cases, drug hypersensitivities were confirmed, mostly against nonopioid analgesic drugs and antibiotics. Multiple logistic regression analysis identified a positive association of antibiotic hypersensitivity with obesity [odds ratio (OR) 5.75, average marginal effect (AME) +24.4%] and age and a negative association with arterial hypertension, female sex, elevated immunoglobulin E (IgE), and allergic rhinitis. Hypersensitivity to nonopioid analgesics was associated with atopic dermatitis (OR 10.28, AME +28.5%), elevated IgE, and arterial hypertension. CONCLUSIONS: Drug-specific cofactors of DHR include obesity for antibiotics and atopic dermatitis for nonopioid analgesics, the knowledge of which may improve the risk calculation for drug provocation tests.