Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Allergy Clin Immunol Pract. 2018 Mar-Apr;6(2):521-527. doi: 10.1016/j.jaip.2017.06.036. Epub 2017 Sep 8.
Hypersensitivity reactions (HRs) to macrolides are rare.
The aim of this study was to evaluate the diagnostic value of in vivo tests in the diagnosis of HRs to macrolides and also to assess cross-reactivity between 4 different macrolides (clarithromycin, dirithromycin, spiramycin, and azithromycin) belonging to 3 different groups.
Twenty-five patients with a history of immediate or delayed-type HRs to at least 1 macrolide and 20 healthy control subjects underwent skin testing for both the culprit and alternative macrolides. Then, all subjects underwent single-blind drug provocation tests (SBDPTs) with these drugs.
Twenty-one patients (84%) described an early reaction, whereas the remaining 4 (16%) had delayed-type reactions. Skin prick test results with culprit macrolides were positive in only 2 patients who had experienced anaphylaxis. These 2 and another 4 patients with anaphylaxis history and 6 patients with negative skin test results who did not give consent were not challenged. A total of 13 patients with negative skin test results were challenged with the culprit drugs and all of them experienced HRs during the SBDPTs. Skin test results with alternative drugs were positive in only 2 patients with negative SBDPT results. Conversely, 5 patients with negative skin test results reacted to SBDPTs with alternative macrolides. In healthy control subjects, the skin test results were positive in 3 patients (1 positivity with clarithromycin, 2 positivity with spiramycin) whereas all DPT results were negative.
Our results suggested that DPT is the only reliable method to predict macrolide hypersensitivity as well as to detect cross-reactivity between macrolides.
对大环内酯类药物的过敏反应（HRs）很少见。
本研究旨在评估体内试验在诊断对大环内酯类药物的 HRs 中的诊断价值，并评估 4 种不同大环内酯类药物（克拉霉素、地红霉素、螺旋霉素和阿奇霉素）之间的交叉反应，这 4 种药物属于 3 个不同的组。
25 例有至少 1 种大环内酯类药物即时或迟发型 HRs 病史的患者和 20 例健康对照者接受了 culprit 和替代大环内酯类药物的皮肤测试。然后，所有受试者接受了这些药物的单盲药物激发试验（SBDPT）。
21 例患者（84%）描述了早期反应，而其余 4 例（16%）有迟发型反应。仅有 2 例发生过敏反应的患者 culprit 大环内酯类药物的皮肤点刺试验结果阳性。这 2 例和另外 4 例有过敏反应病史的患者以及 6 例不同意做皮肤试验的阴性皮肤试验结果的患者没有接受挑战。共有 13 例阴性皮肤试验结果的患者接受了 culprit 药物的挑战，所有患者在 SBDPT 中均发生了 HRs。替代药物的皮肤试验结果仅在 2 例阴性 SBDPT 结果的患者中呈阳性。相反，5 例阴性皮肤试验结果的患者对替代大环内酯类药物的 SBDPT 反应。在健康对照组中，有 3 例患者（1 例对克拉霉素阳性，2 例对螺旋霉素阳性）的皮肤试验结果阳性，而所有 DPT 结果均为阴性。
我们的结果表明，DPT 是预测大环内酯类药物过敏以及检测大环内酯类药物之间交叉反应的唯一可靠方法。
