Characterizing drug allergy management among allergists in Canada: a national survey study

Background Unverified drug allergy labels are common and associated with significant patient harm, yet infrastructure and testing practices vary across clinical settings in Canada. Objective To characterize variability in drug allergy management among allergists in Canada and identify setting-specific barriers to drug allergy testing and desensitization. Methods We developed a peer-reviewed 40-item survey, distributed via the Canadian Society of Allergy and Clinical Immunology, to assess practice patterns, testing modalities, and perceived barriers among allergists. Descriptive statistics and Fisher’s exact test were used to evaluate responses by practice setting. Results Sixty-six allergists responded (30% estimated response rate), with 48.4% solely practicing in community clinics and 21.9% solely in hospital-based clinics. While 87.9% performed some form of drug allergy testing, hospital-based allergists were significantly more likely to perform intradermal (81.1% vs. 48.7%, p = 0.004) and patch testing (38.2% vs. 8.8%, p = 0.009), as well as non-oral drug challenges (63.6% vs. 20.0%, p = 0.0005). Common barriers included a lack of nursing support and inadequate reimbursement. Conclusion Drug allergy management practices vary substantially across Canada, with drug allergy testing being more frequently performed by allergists practicing in hospital-based clinics than by those in community-based clinics. Findings support the need for equitable access to testing infrastructure and system-level investments in improving drug allergy testing services.