Cross-reactivity and tolerability of imipenem in patients with delayed-type, cell-mediated hypersensitivity to β-lactams
| Autor: | Eleonora Nucera, Lucilla Pascolini, Marzia Decinti, Giorgia Altomonte, Carla Lombardo, Giampiero Patriarca, Domenico Schiavino, Alessandro Buonomo |
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| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Imipenem Allergy Cilastatin business.industry Immunology biochemical phenomena metabolism and nutrition medicine.disease Gastroenterology Meropenem Penicillin Tolerability Delayed hypersensitivity Internal medicine polycyclic compounds medicine Immunology and Allergy Dosing business medicine.drug |
| Zdroj: | Allergy. 64:1644-1648 |
| ISSN: | 0105-4538 |
| DOI: | 10.1111/j.1398-9995.2009.02058.x |
| Popis: | Background: Administration of imipenem-cilastatin to patients with IgE-mediated hypersensitivity to β-lactams has always been considered potentially harmful. Recent studies have demonstrated the tolerability of carbapenems (imipenem-cilastatin and meropenem) in patients with IgE-mediated hypersensitivity to β-lactams; there are no studies on this topic regarding patients with cell-mediated allergy to β-lactams. The aim of this study is to assess cross-reactivity and tolerability of imipenem in patients with cell-mediated allergy to β-lactams. Methods: From our database we selected 73 patients with cell-mediated allergy to β-lactams, diagnosed by means of immediate-type skin tests, delayed reading intradermal tests, patch tests and detection of specific IgE. Patients with negative patch tests with imipenem-cilastatin underwent an intramuscular test dosing. Results: Our patients had a total of 94 nonimmediate reactions to penicillins. All patients had positive patch tests and/or delayed reading intradermal tests for at least one of the penicillin reagent tested and negative immediate-type skin tests and specific IgE. Four patients out of 73 had a positive patch tests to at least one penicillin reagent and imipenem-cilastatin showing cross-reactivity. Sixty-four patients underwent the imipenem-cilastatin intramuscular test dosing and none of them had a clinical reaction. Conclusions: Our rate of cross-reactivity between imipenem-cilastatin and other β-lactams was 5.5%. This result is different from previous findings and this may be explained by the fact that we investigated patients with cell-mediated allergy to β-lactams. Patients with cell-mediated allergy to β-lactams should undergo patch tests and a tolerance challenge test before treatment with imipenem-cilastatin. |
| Databáze: | OpenAIRE |
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