Hypersensitivity reactions
Regarding immediate hypersensitivity reactions (IHRs), urticaria is the
most frequent manifestation (68);
furthermore, anaphylaxis can occur (69).
Concerning NIHRs, MPE is described to occur independently (70) or only
in presence of a concurrent infection (71). Azithromycin has been
implicated in contact dermatitis in occupational
(72) and non-occupational settings
(73). Cases of fixed drug eruption (FDE)
(74), AGEP (75) and Drug Reaction with
Eosinophilia and Systemic Symptoms (DRESS) (76), SJS (77,78),
leukocytoclastic vasculitis (79), and
hypersensitivity myocarditis (80) were
reported.
Diagnosis is complex as skin testing is not validated, presenting
discrepancies in non-irritating dilutions for SPT and intradermal test
(IDT) (81,82). For NIHRs, positive responses to patch tests (PTs) were
described (72). In addition, no validatedin vitro tests are available
(83). Oral DPT remains as the gold
standard for diagnosis (84). A successful desensitization protocol was
reported in a case of mast cell activation syndrome
(85).