Half of Physicians Struggle to Consistently Manage Drug Hypersensitivity

A study found that, although physicians had positive attitudes toward drug allergy management, only half (50.3%) consistently recognized and managed drug hypersensitivity reactions.1

“This finding is concerning, as delayed recognition and intervention can lead to severe patient outcomes, including anaphylactic shock and death,” wrote lead investigator Elias A. Alraquibah, from the department of medicine at Qassim University in Saudi Arabia. “Institutions should prioritize thorough training courses covering case-based learning, simulation drills, and standardized anaphylaxis diagnosis and treatment procedures.”

Studies have previously reported variance in physicians’ attitudes and practice patterns regarding drug-induced anaphylaxis.2 This inconsistency could be the difference between saving a patient from a life-threatening hypersensitivity reaction or not.

Investigators conducted a cross-sectional study to assess physicians’ attitudes and practices related to drug-induced allergies.1 The study assessed 167 physicians across 4 hospitals in the Qassim region—King Fahad Specialist Hospital, Buraydah Central Hospital, King Saud Hospital, and Maternity and Children Hospital—who were actively involved in patient care across secondary and tertiary hospitals. The study excluded physicians who were administrative staff, temporary leave personnel, and those without direct patient contact.

Alraquibah used a validated structure questionnaire to collect data between 2023 and 2024 on demographic characteristics, attitude toward drug allergy management, and clinical practices. The questionnaire was distributed both in person and via a Google form.

Most of the sample was male (81.4%) and had a bachelor’s degree (54.5%). Participants worked as residents or fellows (46.1%), consultants or specialists (41.3%), and interns (12.6%). The majority worked in tertiary hospitals (80.2%), but some worked in secondary hospitals (19.8%).

The study found that most physicians had positive attitudes toward drug allergy management, with 91.6% agreeing that healthcare providers should receive advanced training in drug hypersensitivity reactions. More than half of the participants (61.6%) believed that in vivo or in vitro drug testing is important before administration, while 29.3% were uncertain and 9% disagreed.

When it came to self-perceived knowledge of drug hypersensitivity reactions, 40.1% reported satisfaction in their understanding, 24.6% reported uncertainty, and 22.8% reported dissatisfaction. A large percentage of physicians (91.6%) agreed that drug allergies negatively impact a patient’s quality of life, but despite that, only 45.6% reported the frequency of drug allergies in their daily practice.

Nearly half (47.3%) of the physicians reported routinely completing drug allergy testing, though the study observed low rates of accurate interpretation (31.9%). Only 47.3% reported that drug allergy testing was available upon request, and 6.1% reported that it was neither available nor accessible.

Moreover, 65.7% of the physicians reported obtaining allergy histories in their routine care. Yet only 20.1% performed proper skin test controls.

Practice patterns varied across physicians, with 50.3% consistently recognizing and promptly managing drug hypersensitivity reactions. The study showed that access to specialized consultations was inconsistent, with 39.5% relying on internal medicine specialists and 31.1% on consulted immunologists. A total of 13.8% had no access to allergy specialists.

The availability of guidelines varied, with 44.3% reporting that their institutions had them and 17.4% reporting that they had no guidelines available. Physicians’ participation in continuous medical education varied; only 16.8% regularly attended allergy-related training, and 29.4% rarely or never did. Many also had difficulties finding allergy-related patient information; only 34.3% always found necessary records.

“These findings underscore the need for targeted educational interventions and standardized institutional protocols to enhance physicians' knowledge and clinical practices,” investigators concluded. “We recommend implementing mandatory CME programs focused on drug hypersensitivity, including case-based learning and simulation training for anaphylaxis management.”

References

1. Alraqibah EA. Physicians' Attitudes and Practices Regarding Drug Allergy Management: A Cross-Sectional Study. Cureus. 2025 Apr 10;17(4):e82012. doi: 10.7759/cureus.82012. PMID: 40351893; PMCID: PMC12065473.

2. Kwan MSK, Tan SL, Keowmani T, et al. Drug allergy knowledge, attitude, and practice: A survey among doctors and pharmacists in public health facilities of Sabah, Malaysia. Asia Pac Allergy. 2023;13(3):121-126. doi:10.5415/apallergy.0000000000000115