Paul Rouzaire1, Audrey Nosbaum2, Christine Mullet3, Nathalie Diot3, Rolande Dubost3, Françoise Bienvenu4, Laurence Guilloux5, Vincent Piriou3, Jacques Bienvenu6, Frédéric Bérard2. 1. Immunology Laboratory, CHU Lyon-Sud, Pierre Bénite Cedex, France; Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France. Electronic address: porouzaire@chu-clermontferrand.fr. 2. Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France; Department of Allergy and Clinical Immunology, CHU Lyon-Sud, Pierre Bénite Cedex, France. 3. Department of Anesthesia, CHU Lyon, Pierre Bénite Cedex, France. 4. Immunology Laboratory, CHU Lyon-Sud, Pierre Bénite Cedex, France. 5. Biomnis Laboratory, Lyon, France. 6. Immunology Laboratory, CHU Lyon-Sud, Pierre Bénite Cedex, France; Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France.
Abstract
BACKGROUND: We identified a case of quinolone allergic hypersensitivity associated with quaternary ammonium (QA) sensitization, the allergic determinant of neuromuscular blocking agents (NMBAs). Concomitant sensitization to several chemically different drugs is rarely reported and raises the question of a nonfortuitous association. OBJECTIVE: We evaluated a potential association between quinolone immediate allergic hypersensitivity and NMBA sensitization. METHODS: QA-specific IgE detection was prospectively performed in 26 patients who presented an immediate hypersensitivity reaction to quinolones: 17 with a confirmed allergic hypersensitivity and 9 with allergic hypersensitivity not confirmed. We also included a control population of 88 outpatients without a history of quinolone or NMBA hypersensitivity. Patients with positive QA-specific IgE benefited from a NMBA allergologic workup. RESULTS: The prevalence of positive QA-specific IgE was significantly higher in patients with quinolone allergic hypersensitivity (9/17, 53%) compared with patients with allergic hypersensitivity not confirmed (1/9, 11%) than in controls (3/88, 3.4%). In the quinolone allergic population, ofloxacin elicited inhibition of the 4 positive QA-specific IgE sera tested, in a dose-response manner. Among the 9 patients with positive QA-specific IgE, the QA sensitization (positivity of specific IgE) was confirmed by positive skin tests and/or basophil activation tests to at least 1 NMBA in 5 of the 7 tested patients. CONCLUSION: We report here the first documentation of a high prevalence of QA sensitization in patients with quinolone allergic hypersensitivity. These results suggest a new way for NMBA sensitization. It thus seems appropriate to investigate NMBA sensitization when quinolone allergic hypersensitivity is diagnosed.
BACKGROUND: We identified a case of quinolone allergic hypersensitivity associated with quaternary ammonium (QA) sensitization, the allergic determinant of neuromuscular blocking agents (NMBAs). Concomitant sensitization to several chemically different drugs is rarely reported and raises the question of a nonfortuitous association. OBJECTIVE: We evaluated a potential association between quinolone immediate allergic hypersensitivity and NMBA sensitization. METHODS:QA-specific IgE detection was prospectively performed in 26 patients who presented an immediate hypersensitivity reaction to quinolones: 17 with a confirmed allergic hypersensitivity and 9 with allergic hypersensitivity not confirmed. We also included a control population of 88 outpatients without a history of quinolone or NMBA hypersensitivity. Patients with positive QA-specific IgE benefited from a NMBA allergologic workup. RESULTS: The prevalence of positive QA-specific IgE was significantly higher in patients with quinolone allergic hypersensitivity (9/17, 53%) compared with patients with allergic hypersensitivity not confirmed (1/9, 11%) than in controls (3/88, 3.4%). In the quinolone allergic population, ofloxacin elicited inhibition of the 4 positive QA-specific IgE sera tested, in a dose-response manner. Among the 9 patients with positive QA-specific IgE, the QA sensitization (positivity of specific IgE) was confirmed by positive skin tests and/or basophil activation tests to at least 1 NMBA in 5 of the 7 tested patients. CONCLUSION: We report here the first documentation of a high prevalence of QA sensitization in patients with quinolone allergic hypersensitivity. These results suggest a new way for NMBA sensitization. It thus seems appropriate to investigate NMBA sensitization when quinolone allergic hypersensitivity is diagnosed.
Authors: Mario Sánchez-Borges; Bernard Thong; Miguel Blanca; Luis Felipe Chiaverini Ensina; Sandra González-Díaz; Paul A Greenberger; Edgardo Jares; Young-Koo Jee; Luciana Kase-Tanno; David Khan; Jung-Won Park; Werner Pichler; Antonino Romano; Maria José Torres Jaén Journal: World Allergy Organ J Date: 2013-10-31 Impact factor: 4.084