carbapenem allergy

Understanding Carbapenem Allergy

A carbapenem allergy refers to an adverse reaction or hypersensitivity to carbapenems, a class of antibiotics used to treat bacterial infections. The symptoms and severity of a carbapenem allergy can vary from person to person.

• Incidence: Studies have shown that the overall incidence of carbapenem allergic-type reactions among patients with a history of penicillin allergy is around 9-11% (1, 5).
• Risk Factors: Patients with a history of penicillin allergy are at a higher risk of experiencing a carbapenem allergic reaction compared to those without such a history (5). However, it's essential to note that not all patients with a penicillin allergy will experience an adverse reaction to carbapenems.
• Cross-Sensitivity: Carbapenems share some structural similarities with penicillins, which can lead to cross-reactivity in some individuals. This means that people who are allergic to penicillins may also be at risk of experiencing an allergic reaction to carbapenems (10).
• Symptoms: The symptoms of a carbapenem allergy can range from mild to severe and include:
  • Hypersensitivity reactions
  • Nausea and vomiting
  • Seizures (in rare cases)
  • Clostridioides difficile-related diarrhea

It's crucial for healthcare professionals to be aware of the potential risks associated with carbapenem use in patients with a history of penicillin allergy. A thorough medical evaluation and consideration of alternative antibiotic options may be necessary to ensure patient safety.

References:

[1] - The overall incidence of carbapenem allergic-type reactions among the 100 patients in group 1 was 11% (11 of 100 patients), compared with an incidence of 2.7% (3 of 111 patients) in group 2 (P = .024). [4]

[5] - Patients with a history of penicillin allergy had a 9.2% incidence of carbapenem-related allergic reactions, while those without such a history had an incidence of 1.7%. [5]

[10] - Penicillin allergy labels have been associated with second-line antibiotic prescribing. This study measured the impact of penicillin allergy labels on... [15]

Note: The information provided is based on the search results within the context and may not be comprehensive or up-to-date.

Common Adverse Reactions to Carbapenems

Carbapenem allergy can manifest in various ways, ranging from mild to severe symptoms. Here are some common signs and symptoms associated with carbapenem allergy:

• Rash: A maculopapular rash is a common reaction to carbapenems, as seen in 10 out of 19 patients in one study [1].
• Headache, Nausea, Diarrhea, Vomiting: These are among the most common adverse reactions associated with carbapenem use [2].
• Hives and Urticaria: Carbapenem allergy can cause hives, which are itchy, raised patches on the skin.
• Swelling of the lips, Tongue, and Airway (Angioedema): In severe cases, carbapenem allergy can lead to swelling of the face, lips, tongue, or airway, which can cause difficulty breathing [5].
• Flushing and Pruritus: Patients may experience flushing and itching sensations on their skin.
• Eye redness/itching/tearing, Sneezing, Runny nose, and Congestion: These symptoms are often associated with allergic reactions to carbapenems [7].
• Vasculitic rash, Arthralgia, Flu-like symptoms, and Proteinuria: In rare cases, carbapenem allergy can lead to a serum sickness-like reaction, characterized by these symptoms [8].

References:

[1] WA Prescott Jr (2004) - The majority of reactions noted in this study were either rash or hives.

[2] Y Lee (2019)

Based on the provided context, it appears that diagnostic tests for carbapenem (such as meropenem) allergy involve a combination of clinical history, laboratory diagnostics, skin testing, and challenge testing.

Types of Diagnostic Tests:

• Skin Testing: This includes skin prick test, intradermal testing, and delayed reading ID skin tests. For example, a positive delayed reading ID skin test to meropenem was reported in [1].
• Challenge Testing: This is considered the gold standard diagnostic test for beta-lactam allergy, including carbapenems. It involves administering a small dose of the antibiotic orally, followed by increasing doses if tolerated [9].

Procedure:

The diagnostic procedure typically starts with taking an accurate clinical history to assess the patient's symptoms and reaction to the antibiotic [7]. This is followed by skin tests (STs) and/or patch testing, which can be used in combination with challenge testing [8].

• Skin Tests: These include skin prick test, intradermal testing, and delayed reading ID skin tests. For example, a study reported using skin tests and a drug challenge test to meropenem with a duration of 2 h [4].
• Challenge Testing: This involves administering a small dose of the antibiotic orally, followed by increasing doses if tolerated [9].

References:

• A detailed history of allergic reaction is crucial for the assessment of subjects reporting HSRs to β-lactams, followed by skin tests (STs) and/or patch testing [7].
• Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing, and challenge testing [8].
• A positive delayed reading ID skin test to meropenem was reported in [1].
• Skin-prick testing, intradermal testing, and oral and intravenous drug challenges can be used for patients requiring further allergy testing [5].

Note: The numbers in square brackets refer to the context numbers provided.

Treatment Options for Carbapenem Allergy

Individuals who are allergic to carbapenems, a class of antibiotics used to treat severe bacterial infections, may require alternative treatment options.

• Older Antibiotic Agents: Polymyxins, fosfomycin, and aminoglycosides have been rarely used due to efficacy and toxicity concerns [2][3].
• Careful Evaluation: A thorough evaluation of antibiotic allergy and prior tolerance history is essential for optimal treatment [4].

Treatment Considerations

When treating patients with carbapenem allergy, it's crucial to consider the following:

• Alternative Antibiotics: Other antibiotic classes like tetracyclines (e.g., doxycycline), macrolides (e.g., clarithromycin), aminoglycosides (e.g., gentamicin), and glycopeptides (e.g., vancomycin) may be considered [7].
• Penicillin Administration: For patients with a history of an unverified nonanaphylactic cephalosporin allergy, penicillin can be administered without

The differential diagnosis of carbapenem allergy involves considering various conditions that may present similarly to an allergic reaction to carbapenems. According to the literature, drug-induced allergic reactions can affect single organs or multiple organs, making differential diagnosis crucial [5].

Some conditions to consider in the differential diagnosis of drug allergy, including carbapenem allergy, are:

• Severe Cutaneous Adverse Reactions (SCARs): This includes Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), SJS/TEN overlap, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), and Acute Generalized Exanthematous Pustulosis (AGEP) [1].
• Cross-reactivity: This occurs when a patient has an allergy to one antibiotic class and experiences an allergic reaction to another antibiotic class within the same or different category, such as penicillins and carbapenems [2-4].

It's essential to note that a reported history of penicillin allergy often leads to the prescription of carbapenems as a substitute for penicillin to avoid allergic reactions. However, this self-reported allergy needs to be accurately characterized to identify targeted antibiotic stewardship [8].

In addition, diagnostic procedures used in beta-lactam allergy (which includes carbapenem allergy) are usually made up of four components: patient history, laboratory diagnostics, skin testing, and other tests [11].