A systematic review: Can one prescribe carbapenems to patients with IgE-mediated allergy to penicillins or cephalosporins?

Link to article at PubMed

A systematic review: Can one prescribe carbapenems to patients with IgE-mediated allergy to penicillins or cephalosporins?

Clin Infect Dis. 2014 Jul 21;

Authors: Kula B, Djordjevic G, Robinson JL

Abstract
BACKGROUND:  Cross-reactivity is anticipated between penicillins or cephalosporins and carbapenems as all have a beta lactam ring but the true incidence of IgE-mediated cross-reactivity is not known.
METHODS:  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 that were subsequently given a carbapenem. Reactions were classified as proven, suspected or possible IgE-mediated and non-IgE-mediated.
RESULTS:  Ten studies and 12 case reports fit the study criteria, describing 854 participants. 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 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% confidence interval 1.6- 3.7%). Of the sub-set of patients with positive penicillin skin tests (n=295), only one had a hypersensitivity reaction (0.3%; 95% confidence interval 0.06- 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%) including two non-IgE-mediated reactions and one possible IgE-mediated reaction.
CONCLUSIONS:  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 but minimal data is available.

PMID: 25048853 [PubMed - as supplied by publisher]

Leave a Reply

Your email address will not be published. Required fields are marked *