Background: Tacrolimus (TAC) is considered a drug of choice for maintenance immunosuppression among kidney transplant (KTX) recipients. Because of structural resemblances between macrolide antibiotics (azithromycin, clarithromycin or erythromycin) and TAC (a non-antibiotic macrolide), concern has been raised over TAC use in KTX recipients with a known macrolide antibiotic allergy. To date, only one published report describes a bone marrow transplant recipient with a clarithromycin allergy (rash), who also experienced rash and diffuse, generalized erythema with intravenous TAC. The aim of this study was to determine if KTX candidates and recipients with a known macrolide antibiotic allergic reaction also display an allergic reaction to TAC. Methods: We conducted an IRB-approved, single-center, retrospective review of adult patients who were evaluated for KTX at our center between 01/01/01-10/15/17, and had a reported allergy to any macrolide antibiotics. Only patients who subsequently underwent a TAC allergy evaluation and/or subsequently received TAC after KTX were included for analysis. Data were collected through October 31, 2017. Allergies to macrolide antibiotics were defined as a likely IgE-mediated hypersensitivity reaction such as hives, rash, shortness of breath, face, throat or tongue-swelling, or anaphylaxis. Results: Seven patients met inclusion criteria. Three patients underwent TAC allergy testing via skin prick test followed by an oral graded dose challenge pre-KTX and were not found to have an allergy to TAC. One of the tested patients subsequently received a KTX and TAC therapy without complications. Four additional patients did not undergo allergy testing pre-KTX, but received TAC post-KTX without complications. Conclusion: Our results did not identify any cross-reactivity between allergies to a macrolide antibiotic and TAC. It is important to evaluate cross-reactivity between macrolide antibiotic allergies and TAC to ensure that KTX recipients can safely receive current standard of care immunosuppression.

CITATION INFORMATION: Trofe-Clark J., Doshi M., Fadugba O., Lim M. Evaluation of Allergy to Tacrolimus in Kidney Transplant Candidates and Recipients with a History of Macrolide Antibiotic Allergy Am J Transplant. 2017;17 (suppl 3).

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