BACKGROUND: Studies performed on samples larger than 100 subjects with a documented IgE-mediated hypersensitivity to penicillins have demonstrated a cross-reactivity rate of approximately 1% between penicillins and both imipenem and meropenem, whereas a single study found a cross-reactivity rate of 6.2% with aztreonam in 16 such subjects. OBJECTIVE: To assess the cross-reactivity and tolerability of aztreonam and 3 carbapenems (imipenem-cilastatin, meropenem, and ertapenem) in patients with documented IgE-mediated hypersensitivity to penicillins. METHODS: A total of 212 consecutive subjects with immediate reactions to penicillins and positive results on skin tests to at least 1 penicillin reagent underwent skin tests with aztreonam and carbapenems; subjects with negative results were challenged with escalating doses of aztreonam and carbapenems. RESULTS: All subjects displayed negative skin test results to both aztreonam and carbapenems; 211 accepted challenges and tolerated them. Challenges were not followed by full therapeutic courses. CONCLUSIONS: These data indicate the tolerability of both aztreonam and carbapenems in penicillin-allergic subjects. In those who especially require these alternative β-lactams, however, we recommend pretreatment skin tests, both because rare cases of cross-reactivity have been reported and because negative results indicate tolerability.

Gaeta, F., Valluzzi, R., Alonzi, C., Maggioletti, M., Caruso, C., Romano, A., Tolerability of aztreonam and carbapenems in patients with IgE-mediated hypersensitivity to penicillins, <<JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY>>, 2015; 135 (4): 972-976. [doi:10.1016/j.jaci.2014.10.011] [http://hdl.handle.net/10807/72435]

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

Romano, Antonino
2015

Abstract

BACKGROUND: Studies performed on samples larger than 100 subjects with a documented IgE-mediated hypersensitivity to penicillins have demonstrated a cross-reactivity rate of approximately 1% between penicillins and both imipenem and meropenem, whereas a single study found a cross-reactivity rate of 6.2% with aztreonam in 16 such subjects. OBJECTIVE: To assess the cross-reactivity and tolerability of aztreonam and 3 carbapenems (imipenem-cilastatin, meropenem, and ertapenem) in patients with documented IgE-mediated hypersensitivity to penicillins. METHODS: A total of 212 consecutive subjects with immediate reactions to penicillins and positive results on skin tests to at least 1 penicillin reagent underwent skin tests with aztreonam and carbapenems; subjects with negative results were challenged with escalating doses of aztreonam and carbapenems. RESULTS: All subjects displayed negative skin test results to both aztreonam and carbapenems; 211 accepted challenges and tolerated them. Challenges were not followed by full therapeutic courses. CONCLUSIONS: These data indicate the tolerability of both aztreonam and carbapenems in penicillin-allergic subjects. In those who especially require these alternative β-lactams, however, we recommend pretreatment skin tests, both because rare cases of cross-reactivity have been reported and because negative results indicate tolerability.
eng
Gaeta, F., Valluzzi, R., Alonzi, C., Maggioletti, M., Caruso, C., Romano, A., Tolerability of aztreonam and carbapenems in patients with IgE-mediated hypersensitivity to penicillins, <>, 2015; 135 (4): 972-976. [doi:10.1016/j.jaci.2014.10.011] [http://hdl.handle.net/10807/72435]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/72435
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