Validated Tool Improves Accuracy of Patient-Reported Drug Allergy Histories

Investigators at Massachusetts General Hospital validated a drug allergy history tool (DAHT) in a study of 79 participants.1

“The [drug allergy history tool] contains survey items across key domains of the drug allergy history: medication exposure history, timing of reaction, signs and symptoms of reaction, and treatment of reaction,” wrote Kimberly G. Blumenthal MD, MSc, from the division of rheumatology, allergy, and immunology at Massachusetts General Hospital, and colleagues.1

When it comes to drug allergy evaluations, having access to reaction history is critical. Electronic health records can be helpful, creating uniformity in data entry and improving accessibility across healthcare providers. A study published in May 2024 found that information on a patient’s medical history correlated with a positive antibiotic allergy test result. Children with a history of asthma or food allergy had an increased risk of positive allergic testing (P < .05).2

However, allergy records may not always be accurate or complete. Despite drug allergy labels affecting approximately one-third of patients in the United States, only about 14% have true immunologically mediated hypersensitivity reactions.1

This is often the case for patients with penicillin allergy; studies have shown that 90 – 95% of patients with documented penicillin allergies can safely receive these medications after proper evaluation. Unnecessary avoidance of penicillin can have substantial consequences, such as increased healthcare costs, longer hospital stays, increased risk of adverse events, and development of antimicrobial resistance.

Investigators recognized the lack of a validated survey instrument to collect drug allergy history from patients and sought to validate a tool informed by existing questionnaires, peer-reviewed literature, and the expertise of the United States Drug Allergy Registry Consortium.1 The team ensured the tool would work for penicillin allergy by including items used in allergist risk stratification and known predictors of confirmed penicillin allergy.

Investigators revised the drug allergy history tool after 3 rounds of cognitive testing and after assessing for reliability, quality, and validity.1 Test-retest comparisons evaluated cognitive testing, and a concordance analysis against electronic health record allergist documentation evaluated reliability and validity.

Participants, recruited from allergy clinics at the Massachusetts General Hospital, had 1 or more drug allergies. The sample included 79 individuals with a mean age of 49 years and a demographic breakdown of 85% females, 85% White, and 11% Hispanic.1

In total, 50 participants had multiple drug allergy levels, and 29 had single drug allergy labels. The most common drug allergies were penicillin (77%), sulfonamides (32%), cephalosporins (15%), and nonsteroidal anti-inflammatory drugs (8%).1

The drug allergy history tool achieved an acceptable reliability of 86%. The tool had a more complete allergy history than allergist documentation in the electronic health record, with lower median uncertainty (21% DAHT vs 79% electronic health record).1

“The DAHT is a reliable and valid source of patient-reported drug allergy information,” investigators concluded.1 “This tool can be used in clinical care and clinical research to obtain standardized patient-reported drug allergy history."

In an accompanying editorial, author Ricardo D. Zwiener, MD, from the division of allergy and immunology at Hospital Universitario Austral, Buenos Aires, Argentina, outlined several challenges of the drug allergy history tool that may “temper enthusiasm.”3 He listed the lack of confirmatory testing, recall bias for remote reactions, and hurdles with electronic health record integration. Zwiener also noted that the validation cohort lacked diversity.

“The DAHT marks a significant step forward in modernizing drug allergy evaluation by centering patient-reported data within a structured, standardized framework,” Zwiener wrote. 3“Blumenthal and colleagues offer not only a validated tool but a scalable model for rethinking how allergy histories are captured and applied in both clinical and research settings… To fully realize this promise, future efforts must focus on broader validation across populations and seamless [electronic health record] integration.”

References

1. Blumenthal KG, Gundersen DA, Smith LR, et al. The drug allergy history tool (DAHT): Validation of a patient-reported survey instrument. J Allergy Clin Immunol. Published online March 4, 2025. doi:10.1016/j.jaci.2025.02.027

2. Dimitroglou M, Moriki D, Sardeli O, Kartsiouni E, Koumpagioti D, Galani A, Papaevangelou V, Douros K. The Role of Medical History and Allergic Tests in the Analysis of Antibiotic Allergy in the Pediatric Population. Allergies. 2024; 4(2):54-63. https://doi.org/10.3390/allergies4020005

3. Zwiener RD. The Drug Allergy History Tool (DAHT): Enhancing Precision in Drug Allergy Documentation. J Allergy Clin Immunol. Published online July 21, 2025. doi:10.1016/j.jaci.2025.07.009