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Azithromycin is more allergenic than clarithromycin in children with suspected hypersensitivity reaction to
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.
Insights
This study found that azithromycin was more allergenic than clarithromycin in children, with confirmed allergies in 47.3% of azithromycin cases versus 15.5% for clarithromycin. Allergy workups are crucial for diagnosing macrolide antibiotic hypersensitivity in pediatric patients.
Area of Science:
- Pediatric Allergy and Immunology
- Pharmacology
- Infectious Diseases
Background:
- Macrolide antibiotics are generally considered safe with low allergenic potential.
- Limited research exists on macrolide safety, especially concerning allergic reactions in pediatric populations.
- Hypersensitivity reactions to antibiotics are a significant concern in children.
Purpose of the Study:
- To determine the frequency of hypersensitivity reactions to clarithromycin and azithromycin in children.
- To evaluate the diagnostic yield of allergy workups for suspected macrolide antibiotic allergy in pediatric patients.
- To compare the allergenic potential of clarithromycin versus azithromycin in children.
Main Methods:
- Retrospective chart review of 90 children (aged 1-17) with suspected macrolide hypersensitivity.
- Allergy workup included skin tests (prick and intradermal) and serum specific IgE (sIgE) tests.
- Oral provocation tests were utilized when necessary for definitive diagnosis.
Main Results:
- Confirmed reactions to clarithromycin in 15.5% of cases and azithromycin in 47.3% of cases.
- Immediate reactions were reported in 36.2% for clarithromycin and 31.5% for azithromycin.
- Nonimmediate reactions were more common, seen in 63.8% for clarithromycin and 68.42% for azithromycin.
Conclusions:
- A significant percentage of children referred for suspected macrolide allergy are indeed allergic.
- Azithromycin demonstrated a higher rate of confirmed allergic reactions compared to clarithromycin in this pediatric cohort.
- Comprehensive allergy evaluations are essential for accurate diagnosis of antibiotic hypersensitivity in children.
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