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

Objective: This study aimed to evaluate the characteristics of drug allergy alerts (DAAs) and identify false-positive alerts by analyzing prior drug administration records. Materials and Methods: 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. Results: 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, Discussion: 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. Conclusion: Future research should focus on examining strategies to incorporate tolerance assertions into DAA logic to reduce false-positives without compromising safety.