Azithromycin Is More Allergenic Than Clarithromycin in Children With Suspected Hypersensitivity Reaction to Macrolides

Journal of Investigational Allergology and Clinical Immunology

Novembre E²  Cianferoni A¹  Rossi ME²  Pucci N²  Mori F²  Butti D²  Barni S² 

[1] Allergy and Immunology Division, The Children's Hospital of Philadelphia, Pennsylvania, USA;Allergy Unit, A. Meyer Children’s Hospital, University of Florence, Florence, Italy

关键词: Macrolides;    Drug hypersensitivity;    Clarithromycin;    Children;    Azithromycin;   

Others  :  1183610

【 摘 要 】

Background: Macrolides are considered safe antibiotics with reduced allergenic activity. However, studies on the safety of macrolides are scarce, particularly in children.

Objective: The aim of this study was to assess the frequency of hypersensitivity reactions to clarithromycin and azithromycin in a group of children referred to our allergy unit for suspected macrolide allergy.

Methods: We retrospectively reviewed the charts of 90 children aged 1-17 years with symptoms suggestive of hypersensitivity reaction to clarithromycin or azithromycin between December 31, 2008 and December 31, 2013. The allergy workup included skin tests (ie, skin prick tests and/or intradermal tests), determination of serum specific IgE (sIgE) to clarithromycin and azithromycin, and, if necessary to reach a diagnosis, oral provocation tests.

Results: Seventy-seven children completed the allergy workup. A reaction to clarithromycin was recorded in 58 children (75.3%): 21 (36.2%) had a history of immediate reactions, and 37 (63.8%) had a history of nonimmediate reactions. A reaction to azithromycin was recorded in 19 children (24.6%): 6 (31.5%) had a history of immediate reaction, and 13 (68.42%) had a history of nonimmediate reaction. Positiveresults in skin tests and oral provocation tests with the suspect drug confirmed the diagnosis in 15.5% of reactions to clarithromycin (9 of 58) and in 47.3% of reactions to azithromycin (9 of 19) (P=.004).

Conclusion: A complete allergy workup enabled us to confirm a diagnosis of clarithromycin and azithromycin allergy in 15.5% and 47.3% of cases, respectively. Azithromycin was more allergenic than clarithromycin in children.