Social Burden of Drug Allergy and its Prevention

약물 알레르기의 사회적 부담과 관리

Drug allergy exhibits a wide range of clinical features that partly reflect the diversity of the underlying responsible mechanisms. These range from non-immunologic idiosyncratic reactions to Gell and Coombs type 1, 2, 3, and 4 reactions. Consequently, a drug allergy may be difficult to differentiate from an adverse drug reaction. The prevalence of drug allergy varies but is assumed to account for 30% of all adverse drug reactions. In the U.S., 3.1-6.2% of all ward patients are admitted because of adverse drug reactions, and 5-10% of all out-patients or ward patients have suffered an adverse drug reaction. Nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and radiocontrast media are the most common causes of drug allergy, but with the recent introduction of molecular anti-cancer agents, the number of drug allergy cases by these agents is soaring. Drug allergy is an important cause of mortality in admitted patients, and 1 out of every 10,000 admitted patients will die because of a drug allergy. Approximately 30% of adverse drug reactions can be prevented if previous reactions have been monitored and managed adequately. In 2006, a regional pharmacovigilance program was launched in Korea. In addition, the Korean Institute of Drug Safety and Risk Management plans to develop a nationwide drug utilization review program to monitor adverse drug reactions and to provide relevant information from the program to health professionals working in hospitals and clinics, with the aim of preventing drug allergies. Recent studies have shown a strong association between human leukocyte antigen genotypes and the severe cutaneous adverse reactions (SCARs) induced by certain drugs. Genotype prescreening may contribute to the prevention of SCARs induced by culprit drugs such as carbamazepine, allopurinol, and abacavir.