Imipenem in patients with immediate hypersensitivity to penicillins.

New England Journal of Medicine (Impact Factor: 51.66). 07/2006; 354(26):2835-7. DOI:10.1056/NEJMc053529
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    ABSTRACT: Betalactam (BL) immediate-type allergy is influenced by environmental and genetic determinants, as illustrated by differences in worldwide prevalence and ethnicity from a same area and by associations with genes related to atopy. To evaluate the association of atopy with BL allergy. We measured specific Immunoglobulin E (IgE) against prevalent allergens and genetic predictors of atopy, IL13, IL4, IL4RA, IL4, and TNFA, in 340 patients and 340 controls from South of Spain. Total IgE and IgE against mites were at higher concentration in patients. Patients with high total IgE and IgE against prevalent allergens had a slower decrease in BL IgE than nonatopic patients. IL4RA I50V and Q551R were associated with IgE against prevalent allergens and total IgE, respectively, and were also predictors of BL allergy. Interacting determinants of atopy, total IgE, IgE against prevalent allergens, and IL4RA polymorphisms, contribute to the high prevalence of BL allergy in South of Spain.
    Allergy 07/2012; 67(9):1181-5. · 5.88 Impact Factor
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    ABSTRACT: The aim of this review is to present and discuss new developments regarding β-lactam hypersensitivity in patients with cystic fibrosis. It is a common complication that can have significant implications for a patient. Up to 30% of patients have had multiple β-lactam reactions. For the first time drug-specific lymphocytes have been identified in patients with cystic fibrosis. This supports the clinical viewpoint that the nonimmediate reactions seen are T-cell mediated. Furthermore, in piperacillin hypersensitivity mass spectrometric methods have been used to characterise hapten formation both in vivo and in vitro. The synthetic piperacillin-albumin conjugate is able to stimulate patients' lymphocytes and T cell clones. Lymphocyte proliferation was not seen with ceftazidime; this may be due to undetectable protein reactivity in vitro. Skin testing was not sensitive in this cohort and many patients have uncertain allergy status. Desensitisation is performed with some success; however, at present it is not known whether any immune modulation takes place. The piperacillin model provides us with a useful tool to characterise the mechanisms of drug hypersensitivity. Prospective studies are needed to assess how drug sensitivity develops and whether clinical practice could be modified to reduce the risk.
    Current Opinion in Allergy and Clinical Immunology 06/2012; 12(4):369-75. · 3.40 Impact Factor
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    ABSTRACT: Penicillin (PCN) accounts for most cases of antibiotic allergies. Reported PCN allergy deprives the patient from this class of antibiotics and creates hesitancy in using other beta-lactam antibiotics. The aim of this study is to report the prevalence of self-reported PCN allergy among adult patients admitted to the hospital and to examine the probable validity of these reports. A questionnaire was conducted among 192 patients with self-reported PCN allergy who were admitted to a community hospital between July 25, 2011 and January 25, 2012. Patients admitted with an infection and treated with a beta-lactam were also followed until hospital discharge. The mean age of patients at the time of their self-reported allergic reaction was 20.3 years. The most common allergic symptoms reported in decreasing order of frequency were itchy rash, angioedema, and urticaria. Based on analysis of the questionnaires, 121 patients (63.0%) had probable PCN allergy, 54 (28.1%) had possible PCN allergy, and 17 (8.9%) were unlikely to have a PCN allergy. Fifty-one participants (26.6%) had self-reported subsequent exposure to PCN in their life. This subsequent exposure was well tolerated in 86.3% of the participants. Fifty participants (25.9%) had self-reported subsequent exposure to a first generation cephalosporin and it was well tolerated in 78.4% of them. Taking a detailed history from patients with self-reported PCN allergy can help to distinguish a true PCN allergy from a false positive report of allergy and hence allow clinicians to use this important class of antibiotics when truly indicated.
    International Journal of General Medicine 01/2013; 6:905-909.