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Updated: Jul 17, 2026

Contact Hypersensitivity as a Murine Model of Allergic Contact Dermatitis
Published on: September 26, 2022
Occupational allergic contact dermatitis from azithromycin in pharmaceutical workers: a case series
Sanja Milković-Kraus1, Jelena Macan, Bozica Kanceljak-Macan
1Occupational and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia.
Background:
Reports on hypersensitivity reactions to azithromycin associated with therapy or occupational exposure have been rare.
Objectives:
A case series describing clinical characteristics, diagnostic pathways and risk factors in occupational allergic contact dermatitis (ACD) caused by azithromycin in pharmaceutical workers is presented.
Patients/Methods:
7 out of 21 pharmaceutical workers exposed to powdered intermediate and final substances in azithromycin synthesis were referred with workplace-related skin and respiratory symptoms. They all underwent diagnostic procedure involving medical history and examination, patch testing with standard allergens and azithromycin, prick testing with inhalatory allergens and total immunoglobulin E measurement.
Results:
Airborne ACD caused by azithromycin was established in 4 examined workers with positive patch test to azithromycin. 2 workers additionally had positive patch test to intermediate substances. Occupation-related symptoms of urticaria, rhinoconjunctivitis, laryngitis and/or dyspnoea were described in additional 2 workers without clearly positive patch test to azithromycin. 2 atopic workers had a shorter asymptomatic period between the beginning of the exposure to azithromycin and occurrence of skin symptoms than non-atopics (2-3 months versus 1-3 years, respectively).
Conclusions:
Our results suggest that daily manipulation with powdered azithromycin and intermediates is a main route of sensitization. Besides contact sensitization, other possible workplace-related azithromycin hypersensitivity reactions are indicated.
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