Rethinking drug allergies: Improving care for patients

Dr. Erika Lee is helping reshape how drug allergies are understood and managed, ensuring patients receive the treatments they need without unnecessary barriers.

Dr. Lee is an allergist and immunologist at the Transplant Allergy Clinic and General Allergy Clinic at Toronto General Hospital, as well as a courtesy staff physician at the Drug Allergy Clinic at Sunnybrook Health Sciences Centre. She is also an Assistant Professor at the University of Toronto (U of T) and a Clinician Investigator at University Health Network.

Dr. Lee completed her undergraduate degree in immunology at U of T, where she became fascinated by the complexity of the immune system. During medical school at the University of Ottawa, her interest deepened through exposure to multisystem conditions and diagnostically challenging “zebra” cases – interests that naturally led her to allergy and immunology.

“During my residency training, I frequently encountered patients carrying unverified drug allergy labels,” she says. “When these patients truly needed those medications, these labels often became barriers to receiving the most appropriate treatment.”

This experience sparked her interest in drug allergy and the importance of accurate assessment – an area with significant research gaps in Canada, and shaped her path toward an academic career combining clinical care and research.

Recognizing the overlap between allergy, immunology, and dermatology, Dr. Lee pursued a fellowship in inflammatory skin diseases at Women’s College Hospital, where she developed expertise in complex dermatitis and managing challenging skin conditions that intersect with allergic and immunologic disorders.

“The fellowship also gave me the opportunity to focus on my thesis work in severe cutaneous adverse reactions – an area that further strengthened my interest in drug allergy,” she says.

At Toronto General Hospital, Dr. Lee cares for patients with antibiotic or other drug allergy labels before or after transplant.

“My goal is to identify and remove inaccurate but clinically relevant drug allergy labels whenever possible, so that patients have access to the medications they may critically need throughout their transplant journey,” she says.

At Sunnybrook, she manages complex cases involving life-threatening reactions or multiple drug allergy labels, working to clarify true allergies and identify safe alternatives. Across both sites, she treats diverse patient populations with distinct but equally important needs.

One particularly memorable case involved a young woman with end-stage heart failure whose transplant was delayed due to a steroid allergy label.

“Through careful drug allergy testing, I confirmed she did not have a true steroid allergy, allowing her to move forward with the transplant,” says Dr. Lee. “Experiences like this reinforce my passion for drug allergy, patient education, and making sure that inaccurate labels should not become barriers to receiving optimal care.”

Prior to joining the Department of Medicine as faculty, Dr. Lee worked closely with several faculty in the department. While completing her Master of Science, Dr. David Juurlink, internist and head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook, served as her main thesis supervisor and Director of the Division of Dermatology at U of T, Dr. Vincent Piguet, was both a committee member and one of her clinical supervisors, along with Dr. Aaron Drucker during her dermatology fellowship.

“I learned an enormous amount from these mentors on conducting research and preparing for a career as a clinician investigator,” she says. “I am especially grateful for Dr. Juurlink’s mentorship throughout my graduate studies. From him, I learned the principles of population-based research, including how to design and conduct case control studies, work with large databases, analyze results critically, and interpret findings within a broader clinical and public health context.”

These skills have been foundational to her development as an independent researcher. Today, her work focuses on improving drug allergy care by leveraging high-volume clinical data to evaluate diagnostic tools and enhance assessment. She is particularly interested in proactively removing inaccurate beta-lactam and sulfa antibiotic allergy labels in transplant patients, a vulnerable group that benefits from full access to antibiotic options.

“Through this work, I hope to demonstrate not only the safety and effectiveness of proactive antibiotic allergy testing, but also the significant positive impact that removing inaccurate allergy labels can have on patient outcomes,” she says.

Dr. Lee chose to pursue a faculty role at U of T due to her long-standing connection to the institution and its strong academic community.

“It became clear to me that this is an institution that cultivates exceptional clinicians and researchers,” she says. “Being in such an engaging and collaborative environment continuously inspires me to do meaningful work and to advance care in the field I am passionate about.”

Additionally, Dr. Lee saw a unique opportunity to grow the field of drug allergy research as the university has the resources, support, and academic infrastructure needed to make that possible, which made it the ideal place for her to build her career and contribute to improving patient care.

For trainees exploring career paths, Dr. Lee would encourage them to take a closer look at allergy and immunology as it offers fascinating medicine, meaningful patient impact, and countless opportunities to contribute to a rapidly evolving field.

“Allergy and immunology is a wonderful and highly rewarding specialty, but many people don’t fully know what we do or appreciate the breadth of the field,” she says. “There is a tremendous need, especially in academic settings, to advance research across many areas of the field, from drug allergy to immunodeficiency to complex inflammatory conditions.”