Cross-reactivity and tolerability of imipenem in patients with delayed-type, cell-mediated hypersensitivity to beta-lactams.
BACKGROUND
Administration of imipenem-cilastatin to patients with IgE-mediated hypersensitivity to beta-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 beta-lactams; there are no studies on this topic regarding patients with cell-mediated allergy to beta-lactams. The aim of this study is to assess cross-reactivity and tolerability of imipenem in patients with cell-mediated allergy to beta-lactams.


METHODS
From our database we selected 73 patients with cell-mediated allergy to beta-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 beta-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 beta-lactams. Patients with cell-mediated allergy to beta-lactams should undergo patch tests and a tolerance challenge test before treatment with imipenem-cilastatin.
Schiavino
D
D
Department of Allergology, Catholic University of the Sacred Heart, Rome, Italy.
Nucera
E
E
Lombardo
C
C
Decinti
M
M
Pascolini
L
L
Altomonte
G
G
Buonomo
A
A
Patriarca
G
G
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D015377:Cilastatin / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D000077728:Cilastatin, Imipenem Drug Combination; D003429:Cross Reactions; D004338:Drug Combinations; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000276:immunology; D015378:Imipenem / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D007111:Immunity, Cellular; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D012882:Skin Tests; D047090:beta-Lactams / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D047090:beta-Lactams; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination