Macrolides


Widely used class of antibodies which act by inhibiting bacterial protein synthesis.
 
Incidence
Uncommon (0.5 to 2.3% of treatments) for skin reactions.
 
Exceptional for anaphylaxis and acute respiratory failure.
 
Risk Factors
Penicillin allergy.
 
Lupus erythematosus.
 
Clinical manifestations
Anaphylaxis.
 
Asthma (spiramycin ++).
 
Fixed drug eruption (erythromycin), urticaria, maculopapular rash, vasculitis (rare), contact dermatitis.
 
Urticaria, vasculitis, fixed drug eruption and thrombocytopenic
 
purpura recently described with clarithromycin.
 
Diagnostic methods
Cutaneous testing: usually negative with erythromycin. One case with positive skin prick-tests (erythromycin lactobionate 10 mg/ ml)
 
Positive patch-tests in fixed drug eruption (skin lesions).
 
Specific IgE: usually negative. One case with erythromycin specific IgE (sepharose radioimmunoassay).
 
Leukocyte histamine release.
 
Drug re-challenge.
 
Mechanisms
IgE-mediated hypersensitivity in few patients.
 
Management
Avoidance.
 
Cross-reactivity among macrolides has not been demonstrated.

References

  1. Rosina P, Chieregato C, Schena D, "Fixed drug eruption from clarithromycin", Contact. Dermatitis., 1998 ; 38: 105-22
  2. Jorro G, Morales C, Braso J.V, Pelaez A, "Anaphylaxis to erythromycin", Ann. Allergy. Asthma. Immunol., 1996 ; 77: 456-8
  3. Pascual C, Crespo J.F, Quiralte J, Lopez C, Wheeler G, Martin-Esteban M, "In vitro detection of specific IgE antibodies to erythromycin", J. Allergy. Clin. Immunol., 1995 ; 95 (3): 668-71
  4. Igea J.M, Quirce S, De la Hoz B, Fraj J, Pola J, Diez-Gomez M.L, "Adverse cutaneous reactions due to macrolides", Ann. Allergy., 1991 ; 66: 216–8.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.