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

Gaeta, Francesco; Valluzzi, Rocco Luigi; Alonzi, Cristiana; Maggioletti, Michela; Caruso, Cristiano; Romano, Antonino

doi:10.1016/j.jaci.2014.10.011

Cited by 79 publications

(55 citation statements)

References 23 publications

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“…Two studies evaluated patients with IgE-mediated hypersensitivity to penicillin and positive skin tests and found that 0.9 % were skin test positive to imipenem [68,69] or meropenem [68,69], with all skin test negative cases tolerating their administration. These results have been recently confirmed with imipenem, meropenem, and etarpenem [70]. Similar studies performed in children [71,72] had equivalent results detecting a crossreactivity of 0.9 % with meropenem and 0.8 % with imipenem.…”

Section: Carbapenem As An Alternative Treatmentsupporting

confidence: 69%

“…This has been later confirmed in various prospective studies [70,[80][81][82]. The most recent study found that all penicillin-allergic patients with negative skin tests to aztreonam tolerated their administration with escalating doses [70]. Similar results have been published in patients with delayed reactions to penicillins [83].…”

Section: Aztreonam As An Alternative Treatmentmentioning

confidence: 55%

“…Initial studies in experimental animals [12] and humans [78,79] showed that aztreonam has a negligible cross-reactivity with penicillins [78,79]. This has been later confirmed in various prospective studies [70,[80][81][82]. The most recent study found that all penicillin-allergic patients with negative skin tests to aztreonam tolerated their administration with escalating doses [70].…”

Section: Aztreonam As An Alternative Treatmentmentioning

confidence: 91%

“…Similar studies performed in children [71,72] had equivalent results detecting a crossreactivity of 0.9 % with meropenem and 0.8 % with imipenem. These low rates are likely to be due to the majority of IgE antibodies from penicillinallergic patients recognizing specific penicillin determinants and not the shared common nuclear BL [70].…”

Section: Carbapenem As An Alternative Treatmentmentioning

confidence: 99%

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Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

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Opinion statementIt was originally thought that, as all betalactams share a four-member ring, they would cross-react, and so the classical recommendation was for allergic patients to avoid all betalactams. However, later studies found that some individuals selectively responded to one betalactam only and tolerated others. This was shown to be more frequent than initially thought, and this finding has led to a change from the initial recommendations of complete avoidance. Selective responses to amoxicillin are mainly due to recognition of the side chain structure, making benzylpenicillin a safe alternative. These amoxicillin-selective responders comprise up to 55 and 90 % of patients with immediate allergic reactions to amoxicillin and amoxicillin-clavulanic, respectively. Additionally, more than 85 % of penicillin-allergic patients can tolerate cephalosporins with different R 1 side chains, decreasing to 65 % if the side chain is identical. It is known that third and fourth generation cephalosporins are well tolerated by penicillin-allergic patients, probably because their chemical structures differ more from penicillins that those from the first generation. In patients with IgE-mediated allergic reactions to cephalosporins, penicillins can be an alternative treatment in up to 75 % of cases. Moreover, 40 % of patients primarily sensitized to a given cephalosporin also react to others, which might be because some cephaloporins have the same (ceftriaxone and cefotaxime) or very similar (ceftriaxone and cefuroxime) side chain structures. Finally, carbapenems and monobactams are good alternative for patients with penicillin and/or cephalosporin allergy because cross-reactivity occurs in G1 % of these cases. For all betalactams, tolerance is higher in T-cell-mediated reactions than IgE-mediated. These results show that alternative treatments for infectious disease are available to patients with allergic reactions to betalactams, from within the same group of antibiotics. Nevertheless, this general rules need to be analyzed patient by patient, and skin tests and graded challenge with the betalactam that is going to be administered are recommended. Keypoints• Patients with IgE-or T-cell-mediated allergy to betalactams can have selective reactions, specific to one betalactam with good tolerance to others, or be crossreactive, recognizing several different chemically related betalactams.• The percentage of selective reactions to the different betalactam compounds is higher than previously reported and patients should be studied in order to increase the treatment options available.

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Section: Carbapenem As An Alternative Treatmentsupporting

confidence: 69%

Section: Aztreonam As An Alternative Treatmentmentioning

confidence: 55%

Section: Aztreonam As An Alternative Treatmentmentioning

confidence: 91%

Section: Carbapenem As An Alternative Treatmentmentioning

confidence: 99%

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Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Montañez

Ariza

Mayorga

et al. 2015

Curr Treat Options Allergy

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“…Tais reações englobam todos os tipos de reações adversas causadas pela resposta imunológica do paciente a essas drogas, destacando-se a hipersensibilidade imediata, caracterizada pelas respostas denominadas "imediatas e aceleradas", associadas à produção de imunoglobulinas, principalmente da classe IgE 3,4 , e hipersensibilidade tardia, onde a resposta aos antígenos envolve a resposta imune celular 1,5 . O tempo decorrido do contato com o antígeno até o desencadeamento da reação de hipersensibilidade não deve ser o único critério para a identificação do tipo de fenômeno envolvido.…”

Section: Introductionunclassified

Hipersensibilidade aos β-lactâmicos e outros antibióticos. Bases biológicas

Gandolfo¹,

Monteiro²,

Januzzi³

et al. 2016

Arch Health Invest

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3 ResumoEste estudo teve como objetivo avaliar a ocorrência de alergias aos antibióticos e antimicrobianos comumente utilizados em medicina e odontologia, discutindo os mecanismos envolvidos nas reações de hipersensibilidade. Pela literatura verificou-se que a maioria das alergias foi associada com o uso frequente de tais compostos e depende de medicamentos haptenização. A hipersensibilidade pode ser classificada em reacções immediadas e aceleradas, associadas com respostas humorais, ou mediadas por linfócitos T que reconhecem o antigénio apresentado por células apresentadoras de antigenos e liberam citocinas, resultando no recrutamento de diferentes tipos celulare, desencadeando a inflamação do tecido. Além disso, as declarações de 386 pacientes odontológicos foram analisadas e ocorrência de alergias aos antibióticos foram relatadas por 6,2% dos pacientes. As reacções às penicilinas foram predominantes (4,7%), seguidas da sulfanilamida (1,0%) e das cefalosporinas (0,5%). A sintomatologia predominante foi essencialmente cutânea. Também foram analisadas as consequências, diagnóstico e prevenção das alergias aos antimicrobianos. Este estudo concluiu que os β-lactâmicos foram as drogas mais alergênicas e a grande maioria das reações imunes foram desencadeadas contra eles. O tratamento de dessensibilização deve ser considerado a última abordagem clínica devido aos seus riscos para os pacientes. Descritores: Hipersensibilidade a Drogas; Antibacterianos; Alergia e Imunologia. AbstractThis study aimed to evaluate the occurrence of allergies to antibiotics and antimicrobials commonly used in medicine and dentistry, discussing the mechanisms involved in hypersensitivity reactions. In literature, it was verified that most allergies were associated with incremental use of such chemical compounds and depended on the drugs haptenation. Hypersensitivity can be classified into ready mediated and accelerated reactions, associated with humoral responses, or mediated by T lymphocytes that recognize antigen displayed by antigen-presenting cells and release cytokines, resulting in recruitment of several cell types and also trigger a tissue inflammation. In addition, declarations of 386 dental patients were analyzed and allergies were reported by 6.2% of patients. Reactions to penicillins predominated (4.7%), followed by sulfanilamide (1.0%) and cephalosporins (0.5%). Predominant symptomatology was essentially cutaneous. The consequences, diagnosis and prevention of drug allergy were also discussed. This study concluded that β-lactams were the most allergenic drugs and the vast majority of immune reactions were triggered against them. Desensitizing treatment must be considered the last clinical approach due to its risks for patients. Descriptors: Drug Hypersensitivity; Anti-Bacterial Agents; Allergy And Immunology. ResumenEste estudio tuvo como objetivo evaluar la aparición de alergias a los antibióticos y antimicrobianos de uso común en la medicina y la odontología, y discutir los mecanismos implicados en las reacciones de hipersen...

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Penicillin Allergy and Other Antibiotics

Pongdee¹,

Li²

2019

Allergy and Asthma

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

Cited by 79 publications

References 23 publications

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Cross-Reactivity in Betalactam Allergy: Alternative Treatments

Hipersensibilidade aos β-lactâmicos e outros antibióticos. Bases biológicas

Penicillin Allergy and Other Antibiotics

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