Two case reports of delayed-allergic reactions to clindamycin confirmed with a positive lymphocyte transformation test.

Summary: Clindamycin is widely used in the prophylaxis and treatment of infections due to its broad spectrum of antimicrobial activity. Hypersensitivity to clindamycin seems to be not very common (less than 1% of drug-allergic reactions) and it mostly appears as delayed T-cell mediated. For the diagnosis, skin testing is considered to be highly sensitive and rather safe, but cutaneous and systemic reactions have been described. Provocation test is considered the gold standard. However, it includes the possibility of severe reactions. We reported two cases of delayed allergic reaction to clindamycin, confirmed with a positive lymphocyte transformation test, showing this in vitro test like a promising diagnostic method because of its usefulness and safety.

Generalized reactions during skin testing with clindamycin in drug hypersensitivity: a report of 3 cases and review of the literature.

BACKGROUND: The diagnostic approach to drug hypersensitivity includes a detailed medical history, clinical examination, and skin testing and/or oral challenge with a culprit or alternative drug, depending on the type of reaction and the suspected drugs. Although skin testing is considered to be rather safe, cutaneous and systemic, including fatal, reactions have been described. OBJECTIVES: To report 3 cases with generalized delayed reactions after skin testing with clindamycin, and to review the existing literature. METHODS: Thorough clinical examination, blood tests and prick, intradermal and patch tests were performed in 3 patients. RESULTS: All patients experienced generalized maculopapular exanthema after intradermal and patch testing with clindamycin and amoxicillin in the first patient, and clindamycin alone in the second and third patient. None of the patients showed immediate reactions to skin tests, while positive intradermal reactions after 24 h to amoxicillin and clindamycin were observed in the first patient, and positive intradermal reactions after 24 h to clindamycin were observed in the second and third patients. CONCLUSIONS: Skin testing with clindamycin in the diagnosis of drug hypersensitivity carries some risk of adverse reactions. A stepwise and individual diagnostic work-up, considering potential risk factors, and testing in a specialized centre with emergency equipment available is highly recommended.

Comparison of an Enzyme-Linked Immunosorbent Assay with an Immunochromatographic Assay for Detection of Lincomycin in Milk and Honey.

An enzyme-linked immunosorbent assay (ELISA) and an immunochromatographic assay were constructed for the detection of lincomycin (LIN) in both milk and honey samples based on the monoclonal antibody named 5F6. The half-maximum inhibition of ELISA was 0.3 ng/mL after optimizing pH and ionic strength conditions; the limit of detection was 0.07 ng/mL. The cross-reactivity with clindamycin was 0.6%. LIN recovery in spiked milk and honey samples ranged from 84.6% to 115.6% with intra-assay coefficient variations of 1.7-25.4% and inter-assay coefficient variations of 2.7-8.9%. The detection limits were estimated as 2.1 µg/L for milk and 2.1 µg/kg for honey samples. The immunochromatographic assay revealed a LIN cut-off value of 10 ng/mL in PBS, 5 ng/mL in milk, and 120 ng/g in honey, and a visual lower detection limit of 2.5 ng/mL, 1 ng/mL and 30 ng/g in PBS, milk and honey, respectively. The immunochromatographic assay is preferred for large-scale practical application for its simpler pretreatment and satisfied sensitivity compared with ELISA assay.

The prevalence of antibiotic skin test reactivity in a pediatric population.

Although adverse drug reactions (ADRs) are not uncommon, true allergic (i.e., immunologic) reactions are infrequent. Estimates are that only 10% of reported "penicillin (PCN)-allergic" patients have true allergic drug reactions. Most studies of PCN-related ADR have been conducted in adult populations and suggest that the majority of adult patients presenting with PCN allergy history can safely receive the drug. The goal of this study was to examine the outcome of provocative drug challenges to antibiotics in a pediatric population and correlate outcomes with predictive factors. Through chart review, we identified 96 pediatric patients with history of an ADR to antibiotics who underwent skin testing (ST) and/or graded challenges to PCN (n = 52), cephalosporins (n = 7), azithromycin (AZT; n = 24), or clindamycin (n = 4). Of these children with an ADR, 87 (90.6%) tolerated provocative drug challenges and 9 (9.4%) were instructed to continue drug avoidance because of positive ST or failed challenge. Eight of the nine patients continued drug avoidance due to positive PCN ST (n = 4) or ADR during drug PCN challenge (n = 4). All AZT and cephalosporin challenges had negative outcomes, and only one patient did not proceed with the clindamycin challenge after a positive ST. True "antibiotic allergy" denoted by positive ST or failed challenge in patients with a history of ADR occurred in <10% of children included in this study, suggesting that without such testing nearly 90% might be treated with alternative antibiotics unnecessarily.

A sensitive and specific enzyme-linked immunosorbent assay for the detection of lincomycin in food samples.

BACKGROUND: Lincomycin (LIN) is an antibiotic widely used in veterinary medicine to cure infections caused by Gram-positive pathogens. Although the toxicity of LIN is not serious, it will cause adverse effects in humans, such as pseudomembranous enteritis and bacterial resistance. In this study, for the preparation of a LIN derivative, a novel modification method was adopted. The LIN derivative modified at 2-position with a carboxylic group at the end of the spacer was synthesised and coupled to carrier proteins. A LIN polyclonal antibody-based enzyme-linked immunosorbent assay (ELISA) was developed and characterised. RESULTS: The ELISA standard curve was constructed with concentrations of 0.1-1000 ng mL(-1). The IC(50) value for nine standard curves was in the range 23.7-29.3 ng mL(-1) and the limit of detection at a signal-to-noise ratio of 3 was 0.15-0.98 ng mL(-1). The cross-reactivity value of the LIN antibody with clindamycin hydrochloride, a homologue of LIN with similar molecular structure, was 18.9%, while less than 0.1% cross-reactivity was found with seven other compounds. For LIN-spiked food samples, the recoveries and relative standard deviation (RSD) were 76.6-117.6% and 1.7-34.6%, respectively. CONCLUSION: The proposed ELISA can be utilised as a sensitive and specific analytical tool for the detection of LIN in food samples.

Allergy diagnostic testing in clindamycin-induced skin reactions.

BACKGROUND: In clinical practice, clindamycin is increasingly used because of its good tolerability and high efficacy with excellent tissue penetration. However, with increased application of clindamycin, the frequency of side effects such as skin eruptions rises and the need for diagnostic testing to identify clindamycin allergy increases. The aim of this retrospective analysis was to demonstrate the results of skin and challenge tests in cases of clinically suspected clindamycin allergy. METHODS: We evaluated 33 patients with a history of a skin reaction in temporal relation to treatment with clindamycin using standardized patch and prick skin testing. In the case of negative skin tests, oral challenges were performed. RESULTS: Clindamycin hypersensitivity was excluded in 20 patients by negative skin tests and subsequently tolerated oral challenge tests. In 5 patients, positive skin tests strongly suggested delayed-type non-IgE-mediated allergic clindamycin hypersensitivity. In 6 skin test-negative patients (2 patients refused challenge tests), a rash was provoked by controlled challenge tests. CONCLUSIONS: The evaluation of patients with clindamycin-associated skin reactions should include appropriate allergologic tests establishing or excluding the diagnosis of clindamycin hypersensitivity. Combined testing, i.e. skin tests and subsequent challenge tests, appears to be necessary to definitely confirm or rule out the presence of allergic clindamycin hypersensitivity.

Anaphylactic shock following the administration of clindamycin.

A case of anaphylactic shock following the administration of clindamycin is reported. The antibody response was studied by the passive haemagglutination reaction and the presence of haemagglutinating antibodies to both clindamycin and lincomycin was detected. In the discussion, the authors try to account for the causes of development of the mentioned anaphylactic reaction after a single therapeutic dose. In this connection they mention a possible development of haemagglutinating antibodies after the administration of two doses to the patient in an experiment at a long-term interval.