oa Current Allergy & Clinical Immunology - Multiple-drug intolerance syndrome
Case records from the multi-disciplinary drug hypersensitivity clinic : guest review

Volume 29, Issue 3
  • ISSN : 1609-3607



Multiple-drug intolerance syndrome (MDIS) is a condition where patients experience adverse drug reactions to three or more unrelated drugs. The immunological mechanism is unknown, hence the preferred labelling as 'intolerance' as opposed to 'allergy'. MDIS prevalence in South Africa is unknown, but may be as high as 2.1% according to international electronic medical record data. The majority of specialist physicians have encountered these complicated, sometimes frustrating, but always challenging patients.

MDIS patients have high rates of healthcare and medication use, and are highly prone to developing new adverse drug reactions. Risk factors include female gender and multiple non-life-threatening co-morbidities, but not atopy. Antibiotics, particularly cephalosporins and quinolones, together with NSAIDs are the common offending drug classes. The severity of reactions is often overestimated, but life-threatening anaphylaxis or severe cutaneous drug reactions are reported. Optimal management involves the judicious use of drug provocation testing in a safe environment to provide patients and treating physicians with safe drugs as and when medically indicated. Multiple costly and drug allergy testing should be limited.
This brief review first presents an illustrative case from our newly established multi-disciplinary drug hypersensitivity clinic and then provides a literature review on the risk factors, proposed mechanisms and optimal management of MDIS.

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