Azithromycin is more allergenic than clarithromycin in children with suspected hypersensitivity reaction to macrolides.

Abstract

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. Positive results 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.

• Authors: S Barni, D Butti, F Mori, N Pucci, M E Rossi, A Cianferoni, E Novembre
• Journal: Journal of investigational allergology & clinical immunology (J Investig Allergol Clin Immunol) Vol. 25 Issue 2 Pg. 128-32 ( 2015) ISSN: 1018-9068 [Print] Spain
• PMID: 25997306 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Biomarkers
• Immunoglobulin E
• Azithromycin
• Clarithromycin

Topics

• Adolescent
• Age Factors
• Anti-Bacterial Agents (adverse effects)
• Azithromycin (adverse effects)
• Biomarkers (blood)
• Child
• Child, Preschool
• Clarithromycin (adverse effects)
• Drug Hypersensitivity (blood, diagnosis, etiology, immunology)
• Female
• Humans
• Immunoglobulin E (blood)
• Infant
• Intradermal Tests
• Italy
• Male
• Predictive Value of Tests
• Retrospective Studies
• Risk Factors