Evidence map›Paper›PMID 33011300›Full record

ArticleThe journal of allergy and clinical immunology. In practice2021

Vancomycin Hypersensitivity Reactions Documented in Electronic Health Records.

Santiago Alvarez-Arango, Sharmitha Yerneni, Olive Tang, Li Zhou, Christian M Mancini, Suzanne V Blackley, Corinne Allison Keet, Kimberly G Blumenthal

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The journal of allergy and clinical immunology. In practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 4 pooled it
3.7field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 4 syntheses or guidelines pooled it, 40 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Review
  6. Article
  7. Review
  8. Article
  9. A Skin Testing Strategy for Non-IgE-Mediated Reactions Associated With Vancomycin.The journal of allergy and clinical immunology. In practice · 2024
    Article
  10. Non-IgE-Mediated Immediate Drug-Induced Hypersensitivity Reactions.The journal of allergy and clinical immunology. In practice · 2024
    Article
  11. Article
  12. Article
  13. Use of nares swab to de-escalate vancomycin for patients with suspected methicillin-resistantAntimicrobial stewardship & healthcare epidemiology : ASHE · 2023
    Article
  14. Review
  15. Vancomycin Infusion Reaction - Moving beyond "Red Man Syndrome".The New England journal of medicine · 2021
    Article
  16. MRGPRX2 and Adverse Drug Reactions.Frontiers in immunology · 2021
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 1 country.

Santiago Alvarez-ArangoDivision of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University, Baltimore, Md; Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University, Baltimore, Md.
Sharmitha YerneniDivision of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass.
Olive TangJohns Hopkins University School of Medicine, Baltimore, Md.
Li ZhouDivision of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Christian M ManciniDivision of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass.
Suzanne V BlackleyClinical and Quality Analysis, Partners HealthCare, Somerville, Mass.
Corinne Allison KeetDivision of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University, Baltimore, Md.
Kimberly G BlumenthalHarvard Medical School, Boston, Mass; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass; Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Mass. Electronic address: kblumenthal@mgh.harvard.edu.
Johns Hopkins University · USBrigham and Women's Hospital · USHarvard University · USMassachusetts General Hospital · USMass General Brigham · US

Funding

MEDICAL SCIENTIST TRAINING PROGRAMT32GM007309 · NIGMS · JOHNS HOPKINS UNIVERSITY · PI COX, ANDREA L · 1985 to 2019
$43.2M
Medical Scientist Training ProgramT32GM136577 · NIGMS · JOHNS HOPKINS UNIVERSITY · PI ANDREA L COX · 2020 to 2026
$13.4M
Clinical Pharmacology Training ProgramT32GM066691 · NIGMS · JOHNS HOPKINS UNIVERSITY · PI Matthew Michael Ippolito · 2003 to 2026
$6.4M
Clinical Informatics to Advance Epidemiology and Pharmacogenetics of Serious Cutaneous Adverse Drug ReactionsR01AI150295 · NIAID · BRIGHAM AND WOMEN'S HOSPITAL · PI ZHOU, LI · 2019 to 2022
$2.8M
Improving Allergy Documentation and Clinical Decision Support in the EHRR01HS025375 · AHRQ · BRIGHAM AND WOMEN'S HOSPITAL · PI ZHOU, LI · 2018 to 2021
$1.6M
The Clinical and Economic Impact of Penicillin AllergyK01AI125631 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI BLUMENTHAL, KIMBERLY GOLD · 2016 to 2021
$779k
Racial disparities in diabetes- and prediabetes-associated outcomes in older adultsF30DK120160 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI TANG, OLIVE · 2018 to 2020
$145k
AHRQ HHS R01 HS025375NIAID NIH HHS K01 AI125631NIAID NIH HHS R01 AI150295NIDDK NIH HHS F30 DK120160NIGMS NIH HHS T32 GM007309NIGMS NIH HHS T32 GM066691NIGMS NIH HHS T32 GM136577
6 · The paper itself

Abstract

backgroundVancomycin, the most common antimicrobial used in US hospitals, can cause diverse adverse reactions, including hypersensitivity reactions (HSRs). Yet, little is known about vancomycin reactions documented in electronic health records.

objectiveTo describe vancomycin HSR epidemiology from electronic health record allergy data.

methodsThis was a cross-sectional study of patients with 1 or more encounter from 2017 to 2019 and an electronic health record vancomycin drug allergy label (DAL) in 2 US health care systems. We determined prevalence and trends of vancomycin DALs and assessed active DALs by HSR phenotype determined from structured (coded) and unstructured (free-text) data using natural language processing. We investigated demographic associations with documentation of vancomycin red man syndrome (RMS).

resultsAmong 4,490,618 patients, 14,426 (0.3%) had a vancomycin DAL with 18,761 documented reactions (2,248 [12.0%] free-text). Quarterly mean vancomycin DALs added were 253 ± 12 and deleted were 12 ± 2. Of 18,761 vancomycin HSRs, 7,903 (42.1%) were immediate phenotypes and 3,881 (20.7%) were delayed phenotypes. Common HSRs were rash (32% of HSRs) and RMS (16% of HSRs). Anaphylaxis was coded in 6% cases of HSRs. Drug reaction eosinophilia and systemic symptoms syndrome was the most common coded vancomycin severe cutaneous adverse reaction. RMS documentation was more likely for males (odds ratio, 1.30; 95% CI, 1.17-1.44) and less likely for blacks (odds ratio, 0.59; 95% CI, 0.47-0.75).

conclusionsVancomycin causes diverse adverse reactions, including common (eg, RMS) and severe (eg, drug reaction eosinophilia and systemic symptoms syndrome) reactions entered as DAL free-text. Anaphylaxis comprised 6% of documented vancomycin HSRs, although true vancomycin IgE-mediated reactions are exceedingly rare. Improving vancomycin DAL documentation requires more coded entry options, including a coded entry for RMS.

Indexed as

Drug HypersensitivityVancomycinAnti-Bacterial AgentsCross-Sectional StudiesElectronic Health RecordsFemaleHumansMaleAnti-Bacterial AgentsVancomycinAllergyDrug allergy labelDrug reaction eosinophilia and systemic symptoms syndromeElectronic health recordEpidemiologyHypersensitivityInfusion reactionPhenotypeRed man syndromeVancomycin

Identifiers

PMID33011300
PMCPMC7870516
OpenAlexW3090246616

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.