Introduction

Allergic and pseudoallergic drug reactions are reported together. They are rarely confirmed by testing, making statistical analysis imprecise, with both over-reporting and under-reporting. But there is no doubt they are costly and cause considerable morbidity and mortality. Allergic reactions may represent as many as 24% of reported adverse drug reactions.1 Between 10% and 20% of hospitalized patients incur drug reactions (7% in the general population), with about one-third possibly due to hypersensitivity; however, most of these reactions are not reported, especially in pedi-

atrics. Patients experiencing an allergic drug reaction in the hospital result in increased costs of $275 to $600 million annually.4 This financial burden can occur due to several reasons including increased indirect cost of: (a) time and lost labor, (b) the use of costlier alternative medications, and (c) treatment failures. Outpatient rates are not well studied and much harder to collect. Relying on a patient's history without an attempt to verify the relationships between drugs taken and symptoms experienced results in confusion. Health care professionals and patients use the term "drug allergy" in such a general way that it is not medically useful and, further, perpetuates a level of fear and concern in the public and in medical practice that is inappropriate and costly. This same confusion and anxiety sometimes leads medical personnel to ignore or forget "drug allergy" with potentially catastrophic results. Clearly, an understanding of how allergic and pseudoallergic reactions occur and how they might be managed or prevented is important to health care professionals and their patients.

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