ANAPHYLAXIS WITH MEROPENEM
De la Borbolla JM, Nevot S, Navarro B, Ferre L, Claver A, Botey E, Cisteró-Bahíma A
USP Instituto Universitario Dexeus.
Allergy Department.
UAB. Barcelona. Spain
BACKGROUND:
β-lactams are the leading cause of immediate drug allergy reactions. Previous studies show that Carbapenems are tolerated in around 99% of patients and very few cases of meropenen hypersensibility have been reported.
METHODS:
We describe a case of a 25 year old woman who was referred to our Unit suspected of a drug allergic reaction. She presented acute pyelonephritis 6 months earlier, and was initially treated with intravenous ceftriaxone unsuccessfully. She was subsequently treated with intravenous Meropenen. General itching, hives, facial angioedema, dyspnea, and hypotension were observed 15 minutes after the infusion began. Symptoms were treated with intravenous Methylprednisolone and Dexclorfenamine showing relief 4-5 hours later. Gentamicin and Ampicillin were then administered with good tolerance. Ibuprofen, Metamizol and Acetaminophen, which were also administered during the reaction, were later intaken by the patient, with no reaction.
The patient had been treated with intravenous meropenem during a 2 week period, a few months earlier, without incidents.
RESULTS:
The patient presented negative Penicillin G and V, Amoxicillin, Ampicillin, Cefaclor specific IgE levels
Skin prick testing was negative for PPL, MDM, Penicillin G (1000 IU / ml), Amoxicillin (25 mg / ml), Amoxicillin / Clavulanic acid (25 mg / ml), Cefazolin (25 mg / ml), Ceftriaxone (25 mg / ml), Cefuroxime (25 mg / ml), Aztreonam (100 mg / ml) and Ertapenem (100 mg / ml) and presented a wheal diameter of 6 mm with Meropenem (100 mg / ml) The histamine wheal diameter was 10 mm.
Intradermal prick testing with PPL, MDM, Penicillin G (1000 IU / ml), Amoxicillin (25 mg / ml), Amoxicillin / Clavulanic acid (25 mg / ml), Cefazolin (2.5 mg / ml), Ceftriaxone (2.5 mg / ml), Cefuroxime (2.5 mg / ml) Aztreonam (1 and 10 mg / ml), Ertapenem (1, 10 mg / ml) was also negative
Oral Drug challenges (ODC) were performed with Amoxicilin (1 gr), Cefuroxime (500 mg) and Cefixime (400 mg) showing no reaction.
CONCLUSIONS:
We submit a case of selective Meropenem hyper sensibility with severe anaphylaxis. The positive results of the skin prick test confirmed the clinical suspicion and the ODC discarded the possible allergy to other β-lactams.
However, ODC to Aztreonam and other Carbapenems must still be performed due to the possibility of tolerance to other antibiotics in this subfamily.