Abstract
Across all settings, adult females self-report more drug allergies than adult males. Although there is epidemiological evidence of increased drug allergy labeling in post-pubertal females, the evidence base for female sex as a risk factor for true immune-mediated drug hypersensitivity reactions (DHR), particularly in fatal drug-induced anaphylaxis, is low. Focusing on the known immunological mechanisms described in immediate and delayed DHR, layered on known hormonal and genetic sex differences that drive other immune-mediated diseases, could be the key to understanding biological sex variations in DHR. Particular conditions that highlight the impact of drug allergy in women include (1) pregnancy, where a drug allergy label is associated with increased maternal and fetal complications; (2) multiple drug intolerance syndrome, associated with anxiety and depression; and (3) female-predominant autoimmune medical conditions in the context of mislabeling of the drug allergy or increased underlying risk. In this review, we aim to describe the importance of drug allergy in the female population, mainly focusing on the epidemiology and risk, the mechanisms, the associated conditions and psychosocial factors. By performing a detailed analysis of the current literature, we provide focused conclusions and identify existing knowledge gaps that should be prioritized for future research.