Tolerability of aztreonam and carbapenems in patients with IgE-mediated hypersensitivity to penicillins

作者：Gaeta Francesco; Valluzzi Rocco Luigi; Alonzi Cristiana; Maggioletti Michela; Caruso Cristiano; Romano Antonino^*

来源：Journal of Allergy and Clinical Immunology, 2015, 135(4): 972-976.

DOI：10.1016/j.jaci.2014.10.011

• Aztreonam
• cross-reactivity
• ertapenem
• imipenem
• meropenem
• penicillin allergy
• skin tests
• tolerability

Background: Studies performed on samples larger than 100 subjects with a documented IgE-mediated hypersensitivity to penicillins have demonstrated a cross-reactivity rate of approximately 1% between penicillins and both imipenem and meropenem, whereas a single study found a cross-reactivity rate of 6.2% with aztreonam in 16 such subjects.
Objective: To assess the cross-reactivity and tolerability of aztreonam and 3 carbapenems (imipenem-cilastatin, meropenem, and ertapenem) in patients with documented IgE-mediated hypersensitivity to penicillins.
Methods: A total of 212 consecutive subjects with immediate reactions to penicillins and positive results on skin tests to at least 1 penicillin reagent underwent skin tests with aztreonam and carbapenems; subjects with negative results were challenged with escalating doses of aztreonam and carbapenems.
Results: All subjects displayed negative skin test results to both aztreonam and carbapenems; 211 accepted challenges and tolerated them. Challenges were not followed by full therapeutic courses.
Conclusions: These data indicate the tolerability of both aztreonam and carbapenems in penicillin-allergic subjects. In those who especially require these alternative beta-lactams, however, we recommend pretreatment skin tests, both because rare cases of cross-reactivity have been reported and because negative results indicate tolerability.

• 出版日期2015-4