Related Experiment Videos
Anaphylaxis to erythromycin
Background:
Erythromycin and its salts belong to the larger class of macrolides. Erythromycin is well tolerated. The most common side effects are gastrointestinal distress, nausea, and vomiting, which are dose related. Allergic and pseudoallergic reactions due to macrolide antibiotics are uncommon. Anaphylaxis and acute respiratory distress appear in the literature as case reports.
Methods:
We report a 24-year-old man who presented 12 years ago a systemic allergic reaction to penicillin, confirmed by skin tests and detection of specific IgE (RAST). Since then he had tolerated erythromycin on several occasions. Nine months ago, his general practitioner prescribed erythromycin orally as treatment for a respiratory infection. Thirty minutes after taking the first dose, 500 mg, he developed an anaphylactic reaction. The episode subsided with treatment with high dose corticosteroids, antihistamines, and epinephrine. Skin prick tests and intradermal tests were performed with erythromycin at different concentrations. We also measured total IgE and specific IgE to erythromycin by CAP and Phadezym RAST (Pharmacia, Uppsala, Sweden), respectively. We also performed a Prausnitz-Küstner test (PK test), and oral challenge test.
Results:
Skin testing to erythromycin was not helpful because of cutaneous hyperreactiviness. No significant levels of specific IgE to erythromycin were detected. The oral challenge and the Prausnitz-Küstner test were positive.
Conclusions:
The positive history and oral challenge test suggested an anaphylactic reaction to erythromycin. The positive Prausnitz-Küstner test demonstrated the presence of specific IgE to erythromycin.
Insights
A patient experienced anaphylaxis after taking erythromycin, despite previous tolerance. A positive oral challenge and Prausnitz-Küstner test confirmed specific IgE antibodies to erythromycin, indicating a rare allergy to this macrolide antibiotic.
Area of Science:
- Clinical immunology
- Pharmacology
- Allergy and immunology
Background:
- Erythromycin, a macrolide antibiotic, is generally well-tolerated, with dose-related gastrointestinal side effects being most common.
- Severe allergic reactions, including anaphylaxis, are uncommon but documented in medical literature.
- Patients with a history of antibiotic allergies require careful consideration for alternative treatments.
Observation:
- A 24-year-old male with a prior penicillin allergy developed anaphylaxis shortly after ingesting erythromycin.
- Despite previous uneventful exposures to erythromycin, this episode was severe, requiring immediate medical intervention.
- Standard skin testing for erythromycin was inconclusive due to hyperreactivity.
Findings:
- Specific IgE antibodies to erythromycin were not detected by standard RAST testing.
- A positive oral challenge test and Prausnitz-Küstner test strongly indicated an IgE-mediated anaphylactic reaction to erythromycin.
- The case highlights the potential for developing de novo allergies to antibiotics.
Implications:
- This case underscores the importance of considering anaphylaxis in patients presenting with severe reactions to commonly prescribed antibiotics like erythromycin.
- The positive Prausnitz-Küstner test confirms the presence of specific IgE antibodies, aiding in accurate diagnosis of erythromycin allergy.
- Further research may be needed to understand the mechanisms behind rare, yet severe, allergic responses to macrolide antibiotics.