Identifying false-positive drug allergy alerts based on drug tolerance assertions: a retrospective study

This study aimed to evaluate the characteristics of drug allergy alerts (DAAs) and identify false-positive alerts by analyzing prior drug administration records.

We retrospectively analyzed DAAs fired to providers with prescribing authority in 2023 at a large academic medical center in the Southeast to identify data elements that could help reduce clinically irrelevant alerts.

Overall, 101 492 DAAs were triggered in 2023, with a 98.9% override rate. Alerts were fired for 9111 unique patients (an average of 11.1 alerts per patient). Only 9.7% DAAs had a definite match between the prescribed drug and documented allergen, with the remaining 90.3% fired for different drugs under the same class or allergen group. Overall, 70% DAAs were triggered for patients with prior administration of the drug triggering the alert, of these, 74% (52% of all DDAs) occurred in patients who had received the prescribed drug after initial allergy documentation, and 79% (56% of all DAAs) received the same drug again after 2023. Patients who had received prescribed drug previously, definite match were more likely to be overridden than no match (OR = 1.18, 95% CI: 1.03-1.33, P = .013) with a slightly higher override rate (98.9%% [n = 71 357] vs 98.8% [n = 30 135]).

Most DAAs occurred in patients previously exposed to the alerting medication, often after allergy documentation, and over half of the patients continued to receive the same drug after 2023.

Future research should focus on examining strategies to incorporate tolerance assertions into DAA logic to reduce false-positives without compromising safety.