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Evaluation of Suspected Macrolide Allergies in Children

Ayşe Süleyman1, Esra Yücel1, Zeynep Ülker Tamay1

  • 1Division of Pediatric Allergy and Immunology, Department of Pediatrics, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey.

Turkish Archives of Pediatrics
|February 3, 2022
PubMed
Abstract

Insights

Macrolide antibiotic allergy is rare in children, but cross-reactivity between clarithromycin and azithromycin can occur. Oral provocation tests are crucial for diagnosing macrolide allergy.

Area of Science:

  • Pediatric Allergy and Immunology
  • Antibiotic Resistance and Pharmacology

Background:

  • Macrolides are generally considered safe antibiotics with low allergenicity.
  • Limited research exists on macrolide allergy, especially cross-reactivity, in pediatric populations.

Purpose of the Study:

  • To assess clinical features, confirmation rates, and cross-reactivity of suspected clarithromycin or azithromycin allergy in children.
  • To investigate the diagnostic utility of allergy work-up, including drug provocation tests.

Main Methods:

  • Evaluated 61 children with suspected macrolide antibiotic allergy (clarithromycin or azithromycin).
  • Conducted comprehensive allergy work-up, including drug provocation tests, for definitive diagnosis.

Main Results:

  • Macrolide allergy was confirmed in 9.8% of pediatric patients (azithromycin: 18.2%, clarithromycin: 5.1%).
  • No significant difference in confirmation rates between clarithromycin and azithromycin allergy.
  • Cross-reactivity between clarithromycin and azithromycin was observed in 33.3% of patients with azithromycin allergy.

Conclusions:

  • Drug skin tests are insufficient for diagnosing or excluding macrolide allergy.
  • Oral provocation tests are essential for accurate diagnosis of macrolide antibiotic allergy.
  • Cross-reactivity between commonly used pediatric macrolides, clarithromycin and azithromycin, is possible though infrequent.

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