The drug allergy history tool (DAHT): Validation of a patient-reported survey instrument - 29/03/25

Doi : 10.1016/j.jaci.2025.02.027

Kimberly G. Blumenthal, MD, MSc ^a,^b,^⁎ , Daniel A. Gundersen, PhD ^b,^c, Liam R. Smith, BS ^a, Brett Nava-Coulter, MA ^c, Andrew King, MS ^a,^b, Elizabeth J. Phillips, MD ^d,^e, Alexei Gonzalez-Estrada, MD ^f, Iris M. Otani, MD ^g, Allison Ramsey, MD ^h,ⁱ, Aleena Banerji, MD ^a,^b, Timothy G. Chow, MD ^j, Cosby A. Stone, MD, MPH ^d,^e, Whitney A. Salinas, MD ^j, David A. Khan, MD ^j
^a Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
^b Harvard Medical School, Boston, Mass
^c Survey and Qualitative Methods Core, Dana Farber Cancer Institute, Boston, Mass
^d Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
^e Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn
^f Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, Ariz
^g Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco Medical Center, San Francisco, Calif
^h Rochester Regional Health, Rochester, NY
ⁱ Department of Allergy/Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY
^j Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex

^∗Corresponding author: Kimberly G. Blumenthal, MD, MSc, Division of Rheumatology, Allergy, and Immunology, The Mongan Institute, Massachusetts General Hospital 100 Cambridge St, 16th Floor, Boston, MA 02114.Division of RheumatologyAllergy and ImmunologyThe Mongan InstituteMassachusetts General Hospital 100 Cambridge St16th FloorBostonMA02114

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Abstract

Background

While the reaction history is critical for drug allergy evaluations and is typically self-reported, there is no validated survey instrument to collect drug allergy history from patients.

Objective

We validated a survey instrument that collects patient-reported drug allergy history.

Methods

The drug allergy history tool (DAHT) was revised after 3 rounds of cognitive testing, assessed for reliability through test–retest comparisons, and assessed for quality and validity through a concordance analysis against electronic health record allergist documentation. Participants completing testing and surveys had 1 or more drug allergies and were recruited from allergy clinics at Massachusetts General Hospital. Primary evaluative measures were percentage agreement and kappa statistic values.

Results

The DAHT was completed by 79 individuals (mean age, 49 [SD 17] years, 85% female, 85% White, 11% Hispanic ethnicity), 29 with single drug allergy labels and 50 with multiple drug allergy labels. The most common drug allergy labels were penicillins (77%), sulfonamides (32%), cephalosporins (15%), and nonsteroidal anti-inflammatory drugs (8%). The DAHT achieved acceptable test–retest reliability (median κ = 0.64, median agreement = 86%). The DAHT achieved a more complete allergy history than allergist documentation in the electronic health record, with lower median item uncertainty (21% DAHT vs 79% electronic health record) with fair concordance (median κ = 0.21, median agreement = 67%) between the two data sources.

Conclusion

The DAHT is a reliable and valid source of patient-reported drug allergy information. This tool can be used in clinical care and clinical research to obtain standardized patient-reported drug allergy history.

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Key words : Drug allergy, hypersensitivity, reaction, risk stratification, questionnaire, consensus

Abbreviations used : DAHT, EHR, IQR, USDAR