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Cross‐reactivity and tolerability of imipenem in patients with delayed‐type, cell‐mediated hypersensitivity to β‐lactams
Author(s) -
Schiavino D.,
Nucera E.,
Lombardo C.,
Decinti M.,
Pascolini L.,
Altomonte G.,
Buonomo A.,
Patriarca G.
Publication year - 2009
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/j.1398-9995.2009.02058.x
Subject(s) - imipenem/cilastatin , medicine , tolerability , cilastatin , imipenem , penicillin , immunology , pharmacology , antibiotics , adverse effect , microbiology and biotechnology , antibiotic resistance , biology
Background: Administration of imipenem‐cilastatin to patients with IgE‐mediated hypersensitivity to β‐lactams has always been considered potentially harmful. Recent studies have demonstrated the tolerability of carbapenems (imipenem‐cilastatin and meropenem) in patients with IgE‐mediated hypersensitivity to β‐lactams; there are no studies on this topic regarding patients with cell‐mediated allergy to β‐lactams. The aim of this study is to assess cross‐reactivity and tolerability of imipenem in patients with cell‐mediated allergy to β‐lactams. Methods: From our database we selected 73 patients with cell‐mediated allergy to β‐lactams, diagnosed by means of immediate‐type skin tests, delayed reading intradermal tests, patch tests and detection of specific IgE. Patients with negative patch tests with imipenem‐cilastatin underwent an intramuscular test dosing. Results: Our patients had a total of 94 nonimmediate reactions to penicillins. All patients had positive patch tests and/or delayed reading intradermal tests for at least one of the penicillin reagent tested and negative immediate‐type skin tests and specific IgE. Four patients out of 73 had a positive patch tests to at least one penicillin reagent and imipenem‐cilastatin showing cross‐reactivity. Sixty‐four patients underwent the imipenem‐cilastatin intramuscular test dosing and none of them had a clinical reaction. Conclusions: Our rate of cross‐reactivity between imipenem‐cilastatin and other β‐lactams was 5.5%. This result is different from previous findings and this may be explained by the fact that we investigated patients with cell‐mediated allergy to β‐lactams. Patients with cell‐mediated allergy to β‐lactams should undergo patch tests and a tolerance challenge test before treatment with imipenem‐cilastatin.