Macrolides skin tests

The authors speculated on possible cross-sensitivity between tacrolimus and clarithromycin, which are both macrolides, but confirmatory skin-testing was not performed. In addition, the patient had taken many other drugs that might have been responsible. 

Side effects caused by macrolides are uncommon and only a very few seem to be caused by allergic mechanisms confirmed by positive skin tests. Up to now, in vitro tests have produced only limited evidence that an immune response to these antibiotics can indeed be induced in animals as well as in humans. 

Direct skin contact of the veterinarian with animal medications has probably diminished since the 1970s in many countries. Antibiotics (and other medications) used in veterinary medicine and also animal feed are mainly the same as in human medicine, e.g., penicillins, cephalosporins, macrolides, tetracyclines, quinol-ones, sulfas, trimethoprim, antifungals. In addition, other substances have been used in animals only, e.g., penethamate, tylosin, spiramycin, furazolidone. Many antimicrobials are contact sensitizers and may cause contact dermatitis at low concentrations. No routine series for patch testing can be recommended because of the risk of active sensitization. Patch testing should be done with the particular medications with which the veterinarian has been in contact directly or via fodder. Contact urticaria from several antibiotics and disinfectants has also been reported (Hannuksela 1997b Kanerva 1997). 

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