Imipenem in Patients with Immediate Hypersensitivity to Penicillins

Romano, Antonino; Viola, Marinella; Guéant-Rodríguez, Rosa María; Gaeta, Francesco; Pettinato, Rosa; Guéant, Jean Louis

doi:10.1056/nejmc053529

Cited by 126 publications

(79 citation statements)

References 5 publications

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“…Low rates of cross-reactivity on skin testing were also documented in a prospective study between meropenem and penicillin as well as imipenem/cilastatin and penicillin with a prevalence of only 0.9% [188,189]. Importantly, all patients with negative skin tests to carbapenems tolerated graded challenges.…”

Section: Cross-reactivity With Carbapenemsmentioning

confidence: 81%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

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Section: Cross-reactivity With Carbapenemsmentioning

confidence: 81%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

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“…As far as imipenem-cilastatin and meropenem are concerned, taking into account our previous studies, 9,10 we administered an initial dose of one-tenth of the therapeutic dose (50 mg of imipenem plus 50 mg of cilastatin or 0.1 g of meropenem), each on a different day. In case of negative results, 1 hour later we administered a full dose.…”

Section: Aztreonam and Carbapenem Test Dosing (Challenge)mentioning

confidence: 99%

Tolerability of aztreonam and carbapenems in patients with IgE-mediated hypersensitivity to penicillins

Gaeta¹,

Valluzzi²,

Alonzi³

et al. 2015

Journal of Allergy and Clinical Immunology

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“…This has recently been shown with clavulanic acid (Torres et al 2010a) where patients developing an IgE response to AX-clavulanic acid administration responded to BP, AX, or clavulanic acid depending on their age. Cross-reactivity with carbapenems and monobactams in penicillin-allergic patients seems to be very low, less than 1 % with imipenem (Romano et al 2006) and none with aztreonam (Vega et al 1991).…”

Section: Cross-reactivitymentioning

confidence: 92%

Hypersensitivity Reactions to Beta-lactams

Torres

Mayorga

Blanca‐López

et al. 2013

T Lymphocytes as Tools in Diagnostics and Immunotoxicology

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Beta-lactam antibiotics (BLs) are the most frequent cause of hypersensitivity reactions mediated by specific immunological mechanisms, with two main types, IgE reactions or T-cell-dependent responses. From a practical point of view, these reactions can be classified into immediate, for those appearing within 1 h after drug intake, and non-immediate, for those appearing at least 1 h after and usually within 24 h of BL administration. The clinical symptoms differ according to this classification. Urticaria and anaphylaxis are the most frequently recorded symptoms in immediate reactions and maculopapular exanthema and delayed urticaria in non-immediate reactions. Although the exact diagnostic approach differs depending on the underlying mechanism, it is based on the performance of skin testing, laboratory tests, and drug provocation tests.T cells are a key factor in all types of hypersensitivity reactions to BLs, regulating both IgE production or acting as effector cells, with a different profile of cytokine production. A Th1 pattern is observed in both CD4(+) and CD8(+) peripheral T cells in non-immediate reactions, whereas a Th2 pattern is expressed in CD4(+) T cells in immediate reactions.

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Imipenem in Patients with Immediate Hypersensitivity to Penicillins

Cited by 126 publications

References 5 publications

Management of allergy to penicillins and other beta‐lactams

Management of allergy to penicillins and other beta‐lactams

Tolerability of aztreonam and carbapenems in patients with IgE-mediated hypersensitivity to penicillins

Hypersensitivity Reactions to Beta-lactams

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