Inmaculada Doña1, Natalia Pérez-Sánchez2, María Salas2, Esther Barrionuevo3, Arturo Ruiz-San Francisco4, Dolores Hernández Fernández de Rojas5, Jaume Martí-Garrido6, Inmaculada Andreu-Ros7, Ramón López-Salgueiro7, Esther Moreno8, María José Torres9. 1. Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain. Electronic address: inmadd@hotmail.com. 2. Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain. 3. Asthma and Immunoallergic Diseases Research Group, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Allergy Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. 4. Allergy Unit, Hospital Comarcal de Melilla, Melilla. 5. Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica deValència, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, Valencia, Spain; Department of Allergy, Hospital Universitari i Politècnic La Fe, Valencia, Spain. 6. Department of Allergy, Hospital Universitari i Politècnic La Fe, Valencia, Spain. 7. Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica deValència, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, Valencia, Spain. 8. Allergy Service, University Hospital of Salamanca, Salamanca, Spain; Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. 9. Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain; Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain; Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain.
Abstract
BACKGROUND: Quinolones are the second most frequent cause of hypersensitivity reactions (HSRs) to antibiotics. A marked increase in the number of patients with HSRs to quinolones has been detected. OBJECTIVE: To describe the clinical characteristics of patients with HSRs to quinolones and present methods for their diagnosis. METHODS: Patients attending the allergy unit due to reactions suggestive of HSRs to quinolones were prospectively evaluated between 2005 and 2018. Diagnosis was achieved using clinical history, skin tests (STs), basophil activation tests (BATs), and drug provocation tests (DPTs) if ST and BAT results were negative. RESULTS: We included 128 subjects confirmed as having HSRs to quinolones and 42 found to be tolerant. Anaphylaxis was the most frequent entity in immediate HSRs and was most commonly induced by moxifloxacin. Patients were evaluated a median of 150 days (interquartile range, 60-365 days) after the reaction. Of patients who underwent ST and BAT, 40.7% and 70%, respectively, were positive. DPT with a quinolone was performed in 48 cases, giving results depending on the culprit drug: when moxifloxacin was involved, 62.5% of patients gave a positive DPT result to ciprofloxacin, whereas none reacted to levofloxacin. The risk of HSR was 96 times higher in subjects who reported moxifloxacin-induced anaphylaxis and 18 times higher in those reporting immediate reactions compared with clinical entities induced by quinolones other than moxifloxacin and nonimmediate reactions. CONCLUSIONS: The diagnosis of HSR to quinolones is complex. The use of clinical history is essential as a first step. BAT shows higher sensitivity than STs. DPTs can be useful for finding safe alternative quinolones.
BACKGROUND:Quinolones are the second most frequent cause of hypersensitivity reactions (HSRs) to antibiotics. A marked increase in the number of patients with HSRs to quinolones has been detected. OBJECTIVE: To describe the clinical characteristics of patients with HSRs to quinolones and present methods for their diagnosis. METHODS:Patients attending the allergy unit due to reactions suggestive of HSRs to quinolones were prospectively evaluated between 2005 and 2018. Diagnosis was achieved using clinical history, skin tests (STs), basophil activation tests (BATs), and drug provocation tests (DPTs) if ST and BAT results were negative. RESULTS: We included 128 subjects confirmed as having HSRs to quinolones and 42 found to be tolerant. Anaphylaxis was the most frequent entity in immediate HSRs and was most commonly induced by moxifloxacin. Patients were evaluated a median of 150 days (interquartile range, 60-365 days) after the reaction. Of patients who underwent ST and BAT, 40.7% and 70%, respectively, were positive. DPT with a quinolone was performed in 48 cases, giving results depending on the culprit drug: when moxifloxacin was involved, 62.5% of patients gave a positive DPT result to ciprofloxacin, whereas none reacted to levofloxacin. The risk of HSR was 96 times higher in subjects who reported moxifloxacin-induced anaphylaxis and 18 times higher in those reporting immediate reactions compared with clinical entities induced by quinolones other than moxifloxacin and nonimmediate reactions. CONCLUSIONS: The diagnosis of HSR to quinolones is complex. The use of clinical history is essential as a first step. BAT shows higher sensitivity than STs. DPTs can be useful for finding safe alternative quinolones.
Authors: Inmaculada Doña; Marina Labella; Gádor Bogas; Rocío Sáenz de Santa María; María Salas; Adriana Ariza; María José Torres Journal: Antibiotics (Basel) Date: 2022-08-03