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Vol. 43. Issue 1.
Pages 103-104 (January - February 2015)
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Vol. 43. Issue 1.
Pages 103-104 (January - February 2015)
Research Letter
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The Hacettepe Method is an efficient, safe and cost effective method of drug allergy work-up
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A. Fuat Kalyoncu
Hacettepe University School of Medicine, Department of Chest Diseases, Immunology and Allergy Section, Ankara, Turkey
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Table 1. Number of patients tested at the outpatient clinic and the number of OPTs performed for the corresponding year.
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To the Editor,

Drug allergy can be life-threatening, as it negatively affects and delays the treatment of diseases. It also increases healthcare costs by causing a shift towards more expensive alternative drugs.

Drug allergy is one of the most common causes of admission to allergy clinics; it is the most common cause of allergological inpatient consultation in the USA, and is the third most common cause of allergology services consultations in Spain, following bronchial asthma and rhinitis.1,2 However, the number of specialised allergy clinics that address the problem of adult drug allergy is limited in many countries, including Turkey. In addition, waiting for an allergy examination appointment and the performance of drug allergy tests are time consuming. The current gold standard for drug allergy diagnosis and work-up – the oral provocation test (OPT) – takes one day for each drug tested. Different drugs are not usually tested on consecutive days, as a waiting period is necessary (of at least one day) before testing each new drug.

In Turkey there are 70 adult allergy specialists and 22 centres that perform the OPT in adults (data obtained from the Turkish National Society of Allergy and Clinical Immunology). Adverse drug reactions affect 10–20% of hospitalised patients and ≥7% of the general population.3 Considering that the population of Turkey in 2012 was 75,627,384 and that 75.1% of the population is aged >15 years, the number of adult allergy clinics is not sufficient to effectively treat such a common public-health problem as drug allergy.4

Our allergy clinic has a fixed number of two professors and 1–2 fellows who provide patient care. Table 1 shows the total number of patients who were seen at the outpatient clinic and the number of OPTs performed for the corresponding year.

Table 1.

Number of patients tested at the outpatient clinic and the number of OPTs performed for the corresponding year.

Year  Patients seen at the clinic (nOPTs performed (n)a 
2006  1980  250 
2007  3495  300 
2008  5261  275 
2009  5258  400 
2010  5583  375 
2011  5744  405 
2012  5585  394 
a

Each test included 1–3 drugs.

For the reasons stated above the Hacettepe Method has been used at our clinic since 2002 to perform OPTs simultaneously with multiple drugs (i.e. 2–3 drugs from the same or different groups) on the same day in an effort to identify safe alternatives. Use of the Hacettepe Method has reduced the amount of time, money, and manpower used for diagnostic work-up. OPTs were performed by randomly selecting three drugs the patient was not intolerant to based on anamnesis (paracetamol, codeine, meloxicam, rofecoxib, celecoxib, benzydamine, and azapropazone), and those drugs were tested on the same day; the drugs were administered in 30-min intervals at the following doses: lactose (placebo) 50mg; paracetamol 500mg and 750mg; codeine 20mg and 30mg; meloxicam 7.5mg and 15mg; rofecoxib 12.5mg and 25mg; celecoxib 100mg and 150mg; benzydamine 50mg and 75mg; and azapropazone 300mg and 450mg. Tests were completed when a reaction was observed or when the higher test dose of the third drug was reached.5 Subsequently, the identical methodology was used for antibiotic and antibiotic-analgesic drug provocation tests.6,7 We tested 2–3 different groups of antibiotics or antibiotics plus analgesics on the same day.

In our first study, which was published in 2005, the effectiveness of the Hacettepe Method was demonstrated in 84 analgesic-intolerant patients by a decrease in the number of test days from 264 to 148 days.5 Subsequently, we performed a similarly designed study using the Hacettepe Method and 53 antibiotic-allergic patients, and again test days were reduced from 136 to 65.6 The third of our studies was published in 2012, and the Hacettepe Method saved 32 test days in 42 patients diagnosed with antibiotic and analgesic intolerance/allergy, as compared to the conventional OPT method.7 There were no serious adverse reactions in any patients in any of the three studies. Additional research on the Hacettepe Method is ongoing at our clinic.8,9

Based on the findings of our three studies, it is reasonable to conclude that the Hacettepe Method is a safe, cost-effective, time-effective, and manpower-effective method of identifying safe alternative drugs in drug–allergic–allergic/intolerant patients. Considering the difficulty of finding a new approach to an old problem, the Hacettepe Method is recommended for use in all adult allergy clinics worldwide.

Ethical disclosuresConfidentiality of data

The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Protection of human subjects and animals in research

The authors declare that no experiments were performed on humans or animals for this investigation.

References
[1]
P.M. Gamboa.
The epidemiology of drug allergy-related consultations in Spanish Allergology Services: Alergológica-2005.
J Investig Allergol Clin Immunol, 19 (2009), pp. 45-50
[2]
R.W. England, T.C. Ho, D.C. Napoli, J.M. Quinn.
Inpatient consultation of allergy/immunology in a tertiary care setting.
Ann Allergy Asthma Immunol, 90 (2003), pp. 393-397
[3]
E.R. Gomes, P. Demoly.
Epidemiology of hypersensitivity drug reactions.
Curr Opin Allergy Clin Immunol, 5 (2005), pp. 309-316
[5]
A.F. Kalyoncu, G. Karakaya, B. Bozkurt, M. Artvinli.
A new method of oral drug provocation testing for determining safe alternatives for patients with non-steroidal anti-inflammatory drug intolerance: the triple test.
Int Arch Allergy Immunol, 138 (2005), pp. 319-323
[6]
G. Karakaya, S.R. Isik, A.F. Kalyoncu.
Determining safe antibiotics for drug hypersensitive patients with the alternative method of double-triple test.
Allergol Immunopathol, 36 (2008), pp. 264-270
[7]
A.B. Ozturk, E. Celebioglu, G. Karakaya, A.F. Kalyoncu.
Determining safe alternatives for multidrug hypersensitive patients with the alternative triple antibiotic–analgesic test.
Allergol Immunopathol, 41 (2013), pp. 189-193
[8]
E. Celebioglu, G. Karakaya, A.F. Kalyoncu.
The safety of codeine in patients with non-steroidal anti-inflammatory drug hypersensitivity: a preliminary study.
Allergol Immunopathol, 41 (2013), pp. 163-168
[9]
G. Karakaya, E. Celebioglu, A.F. Kalyoncu.
Non-steroidal anti-inflammatory drug hypersensitivity in adults and the factors associated with asthma.
Respir Med, 107 (2013), pp. 967-974

This research letter was not funded from any organisation.

Copyright © 2013. SEICAP
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