ABSTRACT
Background: Some patients report hypersensitivity reactions to many drugs making it difficult to prescribe medications when they fall ill. Aim: To describe the clinical profile of multiple drug hypersensitivity and the results of challenge testing in a large teaching hospital.Methods: We performed a five-year retrospective review of the records of patients who complained of reactions to two or more unrelated drugs and avoided medication because of a fear of developing reactions. Oral challenge testing was carried out in hospital with drugs suspected by the patient to cause reactions and/or commonly prescribed medications. A positive reaction was diagnosed when symptoms and signs resembled previously experienced episodes and there was no such reaction with placebo. Results: Twenty three patients (aged 14-65 years; 19 females) underwent challenge testing. Their complaints had been present for 1-30 years, with 2-40 drug reaction episodes reported. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) were most commonly implicated, and urticaria/angioedema were the most often reported manifestations. The patients underwent 3-27 challenges with 1-24 drugs. Three had positive challenge reactions with various NSAIDs, 13 developed symptoms and signs that were judged not to be true reactions, and 7 had no reactions. None of our patients qualified for a diagnosis of true multiple drug hypersensitivity. Conclusion: Patients who believe they are allergic to multiple, pharmacologically unrelated drugs are usually mistaken. Challenge testing is a reliable way of demonstrating this and providing patients with a list of safe drugs.
ABSTRACT
Background: Disability associated with mental illness is a major contributor to the global burden of disease. The present study was undertaken to assess and compare the disability in long stay patients versus outpatients in a psychiatric hospital using Indian Disability Evaluation Assessment Scale (IDEAS). Methods: Patients suffering from chronic mental illness included in the study. Indian Disability Evaluation Assessment Scale (IDEAS) was applied. Disability was assessed in these patients on all domains of IDEAS. Results: Majority of outpatients (n=13) had percentage of disability (<40%) compared to only 4 inpatients. Conclusions: IDEAS, a new instrument for quantifying and certifying disability in psychiatric patients is useful not only for the outpatients but also for inpatients. Chronic mental illnesses affect all areas of daily functioning, thus posing greater challenge for the rehabilitation of patients and their inclusion in the mainstream.