Cross-reactivity and Tolerability of Ertapenem in Patients With IgE-Mediated Hypersensitivity to β-Lactams
| Autor: | A Di Rienzo, Simona Mezzacappa, Alessandro Buonomo, Eleonora Nucera, Lucilla Pascolini, Valentina Pecora, Domenico Schiavino, Angela Rizzi, Michele Centrone, Anna Giulia Ricci, Arianna Aruanno |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Ertapenem Male Imipenem Allergy medicine.medical_specialty Carbapenem Immunology Cross Reactions beta-Lactams Meropenem Drug Hypersensitivity 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Allergy Unit Internal medicine polycyclic compounds Immunology and Allergy Medicine Humans Aged Skin Tests business.industry Settore MED/09 - MEDICINA INTERNA β-lactams biochemical phenomena metabolism and nutrition Immunoglobulin E Middle Aged medicine.disease Anti-Bacterial Agents 030228 respiratory system Tolerability chemistry Negative Skin Test Female Thienamycins business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of investigational allergologyclinical immunology. 26(2) |
| ISSN: | 1018-9068 |
| Popis: | Background and objective Administration of carbapenems to β-lactam-allergic patients has always been considered potentially harmful because of a 47.4% rate of cross-reactivity to imipenem reported in a single study. Nevertheless, recent studies have shown that the rate of cross-reactivity of imipenem and meropenem with penicillins is lower than 1%. The aim of this study was to evaluate the possibility of using ertapenem in patients with an established IgE-mediated β-lactam allergy. Patients and methods We studied all participants who came to our allergy unit and had a clinical history of immediate hypersensitivity reactions to β-lactams. The inclusion criteria were a positive skin test result to at least 1 β-lactam molecule and/or positive specific IgE (when available). All participants underwent immediate-type skin tests with several β-lactam molecules including ertapenem. Challenges with intravenous ertapenem were performed on 2 different days in patients with negative skin test results. Results We examined 49 patients with a clinical history of immediate reactions to β-lactams. All the patients had positive skin tests and/or positive specific IgE to at least 1 β-lactam reagent and negative carbapenem skin tests. Thirty-six patients agreed to undergo the challenges and 35 tolerated the full dose of ertapenem. Conclusions The practice of avoiding carbapenems in patients with β-lactam allergy should be abandoned considering the very low rate of cross-reactivity. β-Lactam-allergic patients who need ertapenem therapy should undergo skin tests and, if negative, a graded challenge to assess tolerability. |
| Databáze: | OpenAIRE |
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