Imipenem in Patients with Immediate Hypersensitivity to Penicillins
Catholic University of the Sacred Heart , Milano, Lombardy, Italy New England Journal of Medicine
(Impact Factor: 55.87).
07/2006; 354(26):2835-7. DOI: 10.1056/NEJMc053529
Available from: cid.oxfordjournals.org
- "Proven IgE- mediated Positive Serbia 3–14 81 Imipenem and meropenem 0 0 0 0 0 Cunha et al (2008)  Proven IgE- mediated NR United States 28–94 51 Meropenem 0 0 0 0 0 Atanaskovic´- Markovicét al (2009)  Proven IgE- mediated Positive Serbia 3–14 42 Imipenem 0 0 0 0 0 Atanaskovic´- Markovicét al (2008)  Proven IgE- mediated Positive Serbia 3–14 26 Meropenem 0 0 0 0 0 Sodhi et al (2004)  Proven IgE- mediated NR United States 32–91 10 Imipenem or meropenem 0 0 0 1 1 Lager et al (2009)  Proven IgE- mediated NR United States >18 7 Imipenem, meropenem, or ertapenem 0 0 0 0 0 Patriarca et al (1999)  Proven IgE- mediated Negative Italy 23–60 3 Imipenem 0 0 0 0 0 Gorman et al (2003)  Proven IgE- mediated Positive Canada 40 1 a Imipenem 0 0 1 0 1 Romano et al (2007)  Suspected IgE- mediated Positive Italy 14–83 35 Meropenem 0 0 0 0 0 Romano et al (2006, 2007 "
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Cross-reactivity between penicillins or cephalosporins and carbapenems is anticipated as all have a beta lactam ring. However, the true incidence of immunoglobulin (Ig)E-mediated cross-reactivity is not known.
A systematic review was conducted to collect and combine all published data on children and adults reported to have a clinical history of IgE-mediated hypersensitivity to a penicillin and/or cephalosporin who were subsequently given a carbapenem. Reactions were classified as proven, suspected, or possible IgE-mediated and non-IgE-mediated.
Ten studies and 12 case reports describing 854 participants fit the study criteria. For patients with previous proven, suspected, or possible IgE-mediated penicillin reactions (N = 838), the incidence of any type of suspected hypersensitivity reaction to a carbapenem was 36/838 (4.3%; 95% confidence interval [CI], 3.1%-5.9%) and the incidence of proven (1/838), suspected (0/838), or possible (19/838) IgE-mediated reactions was 20/838 (2.4%; 95% CI, 1.6%-3.7%). Of the subset of patients with positive penicillin skin tests (n = 295), only 1 had a hypersensitivity reaction (0.3%; 95% CI, .06%-1.9%), and this was a possible IgE-mediated reaction. For patients with previous proven, suspected, or possible IgE-mediated cephalosporin reactions (N = 12), the incidence of any type of hypersensitivity reaction to a carbapenem was 3/12 (25%); this included 2 non-IgE-mediated reactions and 1 possible IgE-mediated reaction.
The cross-reactivity between penicillins and carbapenems for IgE-mediated reactions is very low, but caution is still advised. Cross-reactivity rates may be higher between cephalosporins and carbapenems; however, minimal data are available.
Clinical Infectious Diseases 07/2014; 59(8). DOI:10.1093/cid/ciu587 · 8.89 Impact Factor
Available from: PubMed Central
- "On the other hand, patients who are truly allergic to aztreonam can safely receive a β-lactam, except ceftazidime. Both, meropenem and imipenem are well tolerated in penicillin skin-test-positive patients who have a negative skin test to imipenem.48 However, patients with a history of penicillin allergy with a positive skin test to penicillin who require imipenem should receive it by graded challenge. "
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ABSTRACT: Anaphylaxis is an increasingly prevalent problem in westernized countries. Therefore, it is of utmost importance that the increasing numbers of patients at risk for anaphylaxis receive proper education on the etiology and risk factors as well as appropriate treatment of anaphylaxis with epinephrine. The physician's role is crucial in order to educate the patients and care takers on effective measures to prevent anaphylaxis and empower them to take charge of early recognition and proper management of an anaphylactic reaction to prevent poor outcomes. This review summarizes the clinical presentation, triggers, avoidance, and management of anaphylaxis.
Journal of Asthma and Allergy 07/2014; 7(7):95-104. DOI:10.2147/JAA.S48611
Available from: Yoon-Seok Chang
- "The usefulness of skin testing for carbapenems has not been determined. Moreover, the cross-reactivity between penicillins and carbapenems is unclear, as studies have reported conflicting findings [21,31-35]. Recently, Romano et al.  published two prospective studies on the utility of skin testing to detect immediate-type allergic reactions to imipenem-cilastatin and meropenem . "
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ABSTRACT: Antibiotic skin testing is a useful procedure for identifying patients with IgE-mediated hypersensitivity to antibiotics. The procedures, however, have not been standardized, and the testing is performed with diverse protocols in Korean hospitals wards. Thus, we examined the current practice of antibiotic skin testing in Korea.
We sent questionnaires to 12 allergists working in secondary or tertiary referral hospitals and collected them by e-mail or fax. The questionnaire included items such as the types and concentrations of the tested antibiotics, the methods of antibiotic skin testing, and the interpretation of the results.
All hospitals responded to the questionnaire. The antibiotic skin testing protocols were variable, inconsistent, and differed with regard to the type and concentrations of antibiotics, the volume injected, and the interpretation of the results. Moreover, the protocols differed from the commonly recommended procedures in the medical literature.
Standardized guidelines for antibiotic skin testing are needed for the safe and effective use of antibiotics in Korea.
The Korean Journal of Internal Medicine 06/2010; 25(2):207-12. DOI:10.3904/kjim.2010.25.2.207 · 1.43 Impact Factor
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