D2.255 - NSAID Hypersensitivity Records: Assessing Documentation Practice, Challenges, and Areas for Improvement

Accurate documentation of drug allergy is essential in preventing adverse drug reactions. The National Institute for Health and Care Excellence (NICE) guidelines provide clear recommendations on documenting drug allergies in the UK. This audit aimed to assess compliance with Non-Steroidal Anti-Inflammatory Drug (NSAID) allergy documentation standards within an adult allergy service and compare documentation between primary (GP) and secondary care settings.

This retrospective audit included patients considered for an alternative NSAID trial with a COX-2 inhibitor challenge between 2023 and 2025. Data were assessed against NICE documentation criteria: (1) whether the allergy was recorded in medical records, (2) whether the specific reaction and severity were documented, and (3) whether documentation was appropriately transferred between systems. A comparison of NSAID hypersensitivity (HS) documentation between a secondary allergy centre and GP records was conducted. Demographic data, comorbidities, number and nature of recorded reactions, and documentation quality were analysed.

The audit included 36 patients (21 males, median age 47 years (IQR 39–63)). The median age at initial reaction was 40 years (IQR 30–54). NSAID HS was documented in 44% of secondary centre records, versus 83% in primary care records. Nineteen patients (52.8%) had only one recorded reaction with NSAIDs. Two patients experienced more than 10 reactions before their assessment. Systemic reactions and rash were the most common NSAID-induced reactions (27.8% each). Rhinitis was the most frequent comorbidity (50%), followed by asthma (30.6%). Severe reactions (anaphylaxis, asthma exacerbation) were more likely to be documented than milder reactions (69.2% vs. 30.4%, p = 0.057). However, no significant difference in documentation rates was observed based on ethnicity (p = 1.0).

This audit highlights suboptimal compliance with drug allergy documentation guidelines for NSAID HS. Documentation discrepancies between primary and secondary care raise concerns. The high number of NSAID-related reactions, combined with a high prevalence of allergic comorbidities, underscores the need for improved documentation and communication of NSAID allergy labelling. Targeted interventions are needed to improve awareness and adherence, with a future re-audit planned to assess the impact of planned changes.