Allergy Unit, A. Meyer Children's Hospital, Department of Pediatrics, the University of Florence, Italy.
S. Anna Hospital, Department of Pediatrics, Ferrara, Italy.
Int J Immunopathol Pharmacol. 2014 Jan-Mar;27(1):121-6. doi: 10.1177/039463201402700116.
Allergic reactions associated to the use of macrolides are uncommon; in particular only two cases of anaphylaxis with erithromycin and clarithromycin have been reported to date. The aim of this study was to investigate macrolide-induced anaphylaxis. Between December 2007 and December 2011, 136 consecutive children were referred to the Allergy Unit of A. Meyer Children's Hospital because of a past history of reactions to macrolides. Allergy work-ups were carried out according to the European Network for Drug Allergy protocol. Anaphylaxis was diagnosed according to the clinical criteria proposed by Sampson et al. and graded according to Brown SGA et al. Sixty-six out of 136 patients completed the allergologic work-up and among them we investigated three cases of anaphylaxis due to azithromycin which included one child with anaphylaxis to both clarithromycin and azithromycin. In two of the children with anaphylaxis, the diagnosis was only confirmed with the skin prick test, the third was positive to the Intradermal Test. The azithromycin allergy shows a surprisingly high sensitivity to the in-vivo tests. Moreover, this study shows that cross-reactivity may occur between different macrolidic molecules; it has even been suggested that macrolide allergies are unlikely to be class allergies.
与大环内酯类药物相关的过敏反应并不常见；迄今为止，仅报告了两例与红霉素和克拉霉素相关的过敏反应。本研究旨在调查大环内酯类药物引起的过敏反应。2007 年 12 月至 2011 年 12 月期间，因对大环内酯类药物有既往过敏史，136 名连续儿童被转至 A. Meyer 儿童医院过敏科。根据欧洲药物过敏网络方案进行过敏检查。根据 Sampson 等人提出的临床标准诊断过敏反应，并根据 Brown SGA 等人的标准进行分级。在 136 名患者中，有 66 名完成了过敏检查，其中我们调查了三例因阿奇霉素引起的过敏反应，其中包括一例对克拉霉素和阿奇霉素均过敏的儿童。在两名过敏反应儿童中，仅皮试可确诊，第三名儿童皮内试验阳性。阿奇霉素过敏对体内试验具有惊人的高敏感性。此外，本研究表明不同大环内酯分子之间可能发生交叉反应；甚至有人认为，大环内酯类过敏不太可能是类过敏。
