Multiple-drug intolerance syndrome: clinical findings and usefulness of challenge tests.
BACKGROUND
Multiple-drug intolerance syndrome (MDIS) is characterized by adverse reactions to several classes of chemically unrelated drugs.


OBJECTIVE
To analyze all patients with a history of adverse reactions to at least 3 drugs at the Allergy Unit of Policlinico Gemelli in a 6-year period to better characterize patients with MDIS and to find safe alternative drugs.


METHODS
We studied 480 patients (aged >16 years) with a history of adverse reactions to at least 3 unrelated drugs and with negative allergy test results. Patients who had experienced mild adverse reactions that remitted spontaneously underwent challenge tests without any premedication (group A). Patients with a clinical history of moderate reactions received sodium cromolyn, 500 mg, before the challenge (group B). Patients with a clinical history of severe reactions or undergoing parenteral challenges were given an antihistamine 30 minutes before the challenge (group C).


RESULTS
In group A, 491 tolerance challenge tests were performed: 414 had negative results and 77 had positive results. In group B, 1,077 tolerance challenge tests were performed: 956 had negative results and 121 had positive results. In group C, 240 tolerance challenge tests were performed: 214 had negative results and 26 had positive results. Comparing the tolerance of alternative drugs in groups A and B, groups A and C, and groups B and C, no significant results were observed (P = .24, .14, and .44, respectively).


CONCLUSIONS
Patients with MDIS can tolerate alternative drugs. Premedication with sodium cromolyn or oral H1-antihistamines may be useful in preventing adverse reactions.
Schiavino
Domenico
D
Allergy Unit, Policlinico "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy.
Nucera
Eleonora
E
Roncallo
Chiara
C
Pollastrini
Emanuela
E
De Pasquale
Tiziana
T
Lombardo
Carla
C
Altomonte
Giorgia
G
Buonomo
Alessandro
A
Patriarca
Giampiero
G
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D004205:Cromolyn Sodium / Q000008:administration & dosage; D003888:Desensitization, Immunologic; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000517:prevention & control*; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D018777:Multiple Chemical Sensitivity / Q000175:diagnosis* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012882:Skin Tests
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006634:Histamine H1 Antagonists; D004205:Cromolyn Sodium