Journals Watch: Drug reactions, obesity and flu vaccine

A review of research impacting primary care, covering drug reactions, obesity, hearing loss and vitamin D. By Dr Suzanne Hunter

Skin reactions are some of the most common drug reactions, such as this urticarial reaction to penicillin (Photograph: SPL)
Skin reactions are some of the most common drug reactions, such as this urticarial reaction to penicillin (Photograph: SPL)

Prevalence of allergic drug reactions
Br J Dermatol 2012; 166: 107-14

Skin reactions are some of the most common adverse drug reactions, which can take the form of immediate reactions, such as urticaria, or later reactions, such as fixed drug reactions or Stephens-Johnson syndrome.

The problem with diagnosing whether a rash is drug induced is that rashes are common and even more so in those who are ill (and therefore on medication).

This study aimed to determine the frequency of actual drug reactions in people with a suspected cutaneous drug reaction.

Over a five-year period, 612 patients with suspected drug skin reactions were referred to dermatologists in two hospitals in Germany and Switzerland. Of these, 141 were thought by the dermatologist to have had a reaction.

They were then given a very thorough investigation and of the 141 cases investigated, 107 were deemed to have a drug cause.

Most reactions were maculopapular rashes or urticaria.

Antibiotics caused 40% of rashes, NSAIDs 21% and contrast media 7.6%. The authors concluded that drugs were being blamed too often for rashes and testing of suspected reactions may be useful.

Comparing anti-smoking and weight loss counselling
Br J Gen Pract 2012; 62: e13-e21

This study compared GPs' ability to counsel obese patients with their ability to counsel patients who smoke. The premise being that GPs are effective and confident about addressing smoking and have been successful as such, but not so at dealing with diet and obesity.

GPs took an online and seminar learning module in behaviour change and counselling then took part in a simulated surgery with an actor in two scenarios; first an overweight patient with raised cholesterol and then a pregnant woman who smoked.

They found that in the smoking consultation the message was clearer and more consistent with a less ambiguous agreed endpoint. With smoking, the benefits of stopping were discussed at several levels and the barriers to change more effectively challenged.

It seems fair to point out that smoking has a much clearer and easily identifiable endpoint to work to (for example, not smoking) than losing weight does.

Inflammatory status and hearing loss
Age Ageing 2012; 41: 92-7

Patients from the Hertfordshire Ageing Study (a cohort of people in Hertfordshire born between 1911 and 1948 who have been followed up long term), were used to investigate an association between hearing loss and inflammation.

It is known that smoking and a high-fat diet are pro- inflammatory and are associated with hearing loss, as is diabetes. Noise-related hearing loss is known to be mediated by cytokines.

A total of 343 men and 268 women aged 63-74 years were given a hearing test and had bloods taken for inflammatory markers (WCC, neutrophils, CRP, IL-6). Not surprisingly older age, being male, smoking and a history of noise exposure were all associated with hearing loss but in addition all the inflammatory markers showed a significant association with hearing loss.

While this information may be of academic interest now, it might point the way to future preventive strategies.

Can one eat well yet cheaply?
Br J Gen Pract 2012; 62: e1-e5

There is a feeling that to eat healthily is more expensive than to eat unhealthily.

This study compared the cost of an unhealthy diet with a healthy one. Children with a BMI on or greater than the 98th centile age five to 16 years kept three-day food diaries.

These were analysed for calorie and fat content and then the diets adjusted to make them healthier. The cost of the actual food eaten and the adjusted meals was then recorded for a budget supermarket, a mid-range supermarket and in standard high street shops.

In the budget supermarket, the original unhealthy meals were the cheapest way to eat at £2.48 a day; buying the healthy meals from here was an extra 33p a day. However, in the standard supermarket the healthy meals were only 4p more expensive than the original meals at £3.44 a day and on the high street it was 17p a day cheaper to eat the healthier menu.

In a standard mid-range supermarket a healthy diet can be almost the same price as an unhealthy diet.

Flu vaccine with dementia
Age Ageing 2012; 41: 64-9

This study looked at vaccine uptake in patients with dementia and in particular whether being resident in a care home or out in the community made a difference to uptake.

It showed that uptake was high in both the community and care homes generally, however patients in care homes with dementia had a higher uptake rate than patients without dementia in care homes (83.3 versus 80.5%), but it was the other way around in the community where non-dementia patients had the higher uptake (74.7 versus 71.4%).

While all these percentages are admirable, especially compared with other developed countries, they could suggest organisational barriers exist, which lead to eligible patients with dementia in the community not receiving the flu jab.

Vitamin D and COPD
Ann Intern Med 2012; 156; 105-14

This study examined whether vitamin D supplementation would reduce exacerbations in patients with COPD. It was a placebo-controlled double-blind trial with patients with moderate to very severe COPD. They were either given 100,000IU vitamin D a month for a year or placebo.

It was found that this made no difference to the number of exacerbations, though a post-hoc analysis showed that vitamin D did reduce exacerbations when there was severe deficiency (<10ng/ml).

  • Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning


These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Consider how you could improve your consultation skills when consulting with obese and overweight patients. Could you agree a more specific outcome for them to aim for?
  • Perform a search for patients within the community with dementia to assess the take-up level of the flu vaccine with a view to targeting them next year.
  • Measure vitamin D levels in patients who have had a COPD exacerbation to see if they have levels of less than 10ng/ml.

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