title: Occupational allergic contact dermatitis from azithromycin in pharmaceutical workers: a case series.
abstract: BACKGROUND
  Reports on hypersensitivity reactions to azithromycin associated with therapy or occupational exposure have been rare.
  
  
  OBJECTIVE
  A case series describing clinical characteristics, diagnostic pathways and risk factors in occupational allergic contact dermatitis (ACD) caused by azithromycin in pharmaceutical workers is presented.
  
  
  METHODS
  7 out of 21 pharmaceutical workers exposed to powdered intermediate and final substances in azithromycin synthesis were referred with workplace-related skin and respiratory symptoms. They all underwent diagnostic procedure involving medical history and examination, patch testing with standard allergens and azithromycin, prick testing with inhalatory allergens and total immunoglobulin E measurement.
  
  
  RESULTS
  Airborne ACD caused by azithromycin was established in 4 examined workers with positive patch test to azithromycin. 2 workers additionally had positive patch test to intermediate substances. Occupation-related symptoms of urticaria, rhinoconjunctivitis, laryngitis and/or dyspnoea were described in additional 2 workers without clearly positive patch test to azithromycin. 2 atopic workers had a shorter asymptomatic period between the beginning of the exposure to azithromycin and occurrence of skin symptoms than non-atopics (2-3 months versus 1-3 years, respectively).
  
  
  CONCLUSIONS
  Our results suggest that daily manipulation with powdered azithromycin and intermediates is a main route of sensitization. Besides contact sensitization, other possible workplace-related azithromycin hypersensitivity reactions are indicated.
authors.affiliation: Occupational and Environmental Medicine Unit, Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Milković-Kraus
authors.forename: Jelena
authors.initials: J
authors.lastname: Macan
authors.forename: Bozica
authors.initials: B
authors.lastname: Kanceljak-Macan
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017963:Azithromycin / Q000009:adverse effects*; D017523:Croatia / Q000453:epidemiology; D017449:Dermatitis, Allergic Contact / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009783:Dermatitis, Occupational / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004345:Drug Industry; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D010328:Patch Tests
chemical_list: D000485:Allergens; D000900:Anti-Bacterial Agents; D007073:Immunoglobulin E; D017963:Azithromycin