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. Key words: β-lactams. IgE-mediated hypersensitivity. Ertapenem. Cross-reactivity.

Buonomo, A., Pascolini, L., Rizzi, A., Aruanno, A., Pecora, V., Ricci, A. G., Mezzacappa, S., Di Rienzo, A., Centrone, M., Nucera, E., Schiavino, D., Cross-reactivity and tolerability of Ertapenem in patients with IgE-mediated hypersensitivity to β-lactams, <<JOURNAL OF INVESTIGATIONAL ALLERGOLOGY & CLINICAL IMMUNOLOGY>>, 2016; (2): 100-105. [doi:10.18176/jiaci.0019] [http://hdl.handle.net/10807/77019]

Cross-reactivity and tolerability of Ertapenem in patients with IgE-mediated hypersensitivity to β-lactams

Buonomo, Alessandro
;
Pascolini, Lucilla
Primo
;
Rizzi, Angela;Aruanno, Arianna;Pecora, Valentina;Ricci, Anna Giulia;Mezzacappa, Simona;Di Rienzo, Alessia;Centrone, Michele;Nucera, Eleonora
Penultimo
;
Schiavino, Domenico
Ultimo
2016

Abstract

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. Key words: β-lactams. IgE-mediated hypersensitivity. Ertapenem. Cross-reactivity.
Inglese
Buonomo, A., Pascolini, L., Rizzi, A., Aruanno, A., Pecora, V., Ricci, A. G., Mezzacappa, S., Di Rienzo, A., Centrone, M., Nucera, E., Schiavino, D., Cross-reactivity and tolerability of Ertapenem in patients with IgE-mediated hypersensitivity to β-lactams, <<JOURNAL OF INVESTIGATIONAL ALLERGOLOGY & CLINICAL IMMUNOLOGY>>, 2016; (2): 100-105. [doi:10.18176/jiaci.0019] [http://hdl.handle.net/10807/77019]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/77019
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