Gangemi S, Ricciardi L, Fedele R, Isola S, Purello-D'Ambrosio F
School and Division of Allergy and Clinical Immunology, University of Messina, Policlinic Pad. H, Messina, Italy.
Allergol Immunopathol (Madr). 2001 Jan-Feb;29(1):31-2. doi: 10.1016/s0301-0546(01)79013-1.
We present the case of bronchospastic reaction to clarithromycin had during a drug challenge test. Personal allergic history was negative for respiratory allergies and positive for adverse drug reactions to general and regional anesthesia and to ceftriaxone. After the administration of 1/4 of therapeutic dose of clarithromycin the patient showed dyspnea, cough and bronchospasm in all the lung fields. The positivity of the test was confirmed by the negativity to the administration of placebo. The quickness and the clinical characteristic of the adverse reaction suggest a pathogenic mechanism of immediate-type hypersensitivity. On reviewing the literature we have found no reports of bronchospastic reaction to clarithromycin. Macrolides are a class of antibiotics mainly used in the last years in place of beta-lactams because of a broad spectrum of action and a low allergic power. In fact, there are few reports on allergic reactions to these molecules. Clarithromycin is one of the latest macrolides, characterised by the presence of a 14-carbon-atom lactone ring as erythromycin, active on a wide spectrum of pathogens.
我们报告了一例在药物激发试验期间发生的对克拉霉素的支气管痉挛反应病例。患者个人过敏史显示，其对呼吸道过敏呈阴性，但对全身麻醉、区域麻醉及头孢曲松的药物不良反应呈阳性。在给予1/4治疗剂量的克拉霉素后，患者出现呼吸困难、咳嗽及双肺野支气管痉挛。安慰剂给药阴性证实了该试验结果为阳性。不良反应的迅速性及临床特征提示速发型超敏反应的发病机制。查阅文献后，我们未发现关于对克拉霉素发生支气管痉挛反应的报道。大环内酯类是一类抗生素，近年来因其抗菌谱广且过敏反应少，主要用于替代β-内酰胺类抗生素。事实上，关于对这些分子发生过敏反应的报道很少。克拉霉素是最新的大环内酯类药物之一，与红霉素一样具有14元碳内酯环，对多种病原体具有活性。
