The Journal of Allergy and Clinical Immunology
Volume 116, Issue 5 , Page 1169, November 2005

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  • Dennis Ledford, MD

      Affiliations

    • James A. Haley VA Hospital, University of South Florida, Tampa, Fla
    • ,
  • Phil Lieberman, MD

      Affiliations

    • Clinical Professor of Medicine and Pediatrics, Division of Allergy/Immunology, University of Tennessee College of Medicine, 7205 Wolf River Blvd, Ste 200, Germantown, TN 38138

published online 04 October 2005.

Article Outline

 

To the Editor:

We thank Dr Meier for identifying the misleading statement in the practice parameters for anaphylaxis1 concerning the use of carbapenem antibiotics (imipenem/cilastin, meropenem, or ertapenem) in individuals with a history of penicillin allergy.2 Penicillin and carbapenems, in contrast with monobactams, cross-react immunologically, as reported in the reference provided by Dr Meier.3 The package insert for meropenem indicates that hypersensitivity to β-lactam antibiotics is a relative contraindication or caution for its use. Retrospective patient reports have not identified a statistically increased risk of reactions when carbapenems are administered to individuals with a history of penicillin allergy.4, 5, 6 These observations have resulted in the suggestion that carbapenems may be reasonable for patients allergic to penicillin. However, caution is advised because immunologic cross-reactivity is documented and a trend for increased allergic reactions to carbapenems in subjects with penicillin allergy has been observed in at least 1 series.5

The standard of care would be to use monobactams, if appropriate, or another antibiotic class in a subject with definite penicillin allergy. Cautious use of carbapenems is a consideration, but there is potential risk, as identified by Dr Meier.

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References 

  1.  Lieberman P,  Kemp SF,  Oppenheimer J,  Lang DM,  Bernstein IL,  Nicklas RAThe diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. 2005;115:S483–S523
  2. Meier EA. Carbapenem cross-reactivity with penicillin. J Allergy Clin Immunol. 2005;116:1169
  3. Saxon A, Beall GN, Rohr AS, Adelman DC. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med. 1984;107:204–215
  4. Sodhi M, Axtell SS, Callahan J, Shekar R. Is it safe to use carbapenems in patients with a history of allergy to penicillin?. J Antimicrob Chemother. 2004;54:1155–1157
  5. Prescott WA, DePestel DD, Ellis JJ, Regal RE. Incidence of carbapenem-associated allergic-type reactions among patients with versus patients without a reported penicillin allergy. Clin Infect Dis. 2004;38:1102–1107
  6. McConnell SA, Penzak SR, Warmack TS, Anaissie EJ, Gubbins PO. Incidence of imipenem hypersensitivity reactions in febrile neutropenic bone marrow transplant patients with a history of penicillin allergy. Clin Infect Dis. 2000;31:1512–1514

PII: S0091-6749(05)01721-5

doi:10.1016/j.jaci.2005.06.037

The Journal of Allergy and Clinical Immunology
Volume 116, Issue 5 , Page 1169, November 2005

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