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Kurtov M, Kilić P, Ikić L, Kurtov K, Dorčić G, Vodanović M, Artuković M, Ikić Matijašević M. Ciprofloxacin-Induced Anaphylactic Reaction Followed by Negative Provocation Test in Response to Levofloxacin: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1784. [PMID: 37893502 PMCID: PMC10608669 DOI: 10.3390/medicina59101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
Fluoroquinolones are a commonly prescribed class of antibiotics due to their broad spectrum of antimicrobial activity, favorable pharmacokinetic properties, ability to switch from parenteral to oral administration, and global availability. After beta-lactams, they are the second most common antibiotic class associated with drug allergies. The mechanism of fluoroquinolone-induced hypersensitivity reactions has not yet been fully understood, so the true incidence of hypersensitivity reactions remains unknown. Cross-reactivity between fluoroquinolones has been the subject of conflicting and limited clinical research. Due to their similar chemical structure, some argue for close cross-reactivity within the group. However, recent studies have produced contradictory results. We present the case of a young patient who had an anaphylactic reaction to ciprofloxacin but was tolerant to levofloxacin, as determined via a skin prick test followed by a drug provocation test. Our findings support the notion that there is little cross-reactivity between fluoroquinolones. Consequently, exposure to another fluoroquinolone in a hospital setting may be beneficial, particularly for patients who lack adequate antibiotic alternatives. However, additional research on this subject is required.
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Affiliation(s)
- Marija Kurtov
- Department of Clinical Pharmacology and Toxicology, University Hospital Sveti Duh, 10000 Zagreb, Croatia
| | - Paula Kilić
- Department of Clinical Immunology, Rheumatology, and Pulmonology, University Hospital Sveti Duh, 10000 Zagreb, Croatia; (P.K.); (M.A.)
| | - Lucija Ikić
- Department of Anatomy and Physiology, University of Applied Health Sciences, 10000 Zagreb, Croatia;
| | - Karlo Kurtov
- Department of Nephrology and Dialysis, University Hospital Merkur, 10000 Zagreb, Croatia;
| | - Gordan Dorčić
- Department of Nephrology and Dialysis, University Hospital Sveti Duh, 10000 Zagreb, Croatia;
| | - Marko Vodanović
- Division of Gastroenterology and Hepatology, University Hospital Sveti Duh, 10000 Zagreb, Croatia;
| | - Marinko Artuković
- Department of Clinical Immunology, Rheumatology, and Pulmonology, University Hospital Sveti Duh, 10000 Zagreb, Croatia; (P.K.); (M.A.)
- Department of Internal Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Marina Ikić Matijašević
- Department of Clinical Immunology, Rheumatology, and Pulmonology, University Hospital Sveti Duh, 10000 Zagreb, Croatia; (P.K.); (M.A.)
- Division of Gastroenterology and Hepatology, University Hospital Sveti Duh, 10000 Zagreb, Croatia;
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2
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Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J, Khan DA, Golden DBK, Shaker M, Stukus DR, Khan DA, Banerji A, Blumenthal KG, Phillips EJ, Solensky R, White AA, Bernstein JA, Chu DK, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Ledford D, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wallace D, Wang J. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol 2022; 150:1333-1393. [PMID: 36122788 DOI: 10.1016/j.jaci.2022.08.028] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Aleena Banerji
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Roland Solensky
- Corvallis Clinic, Oregon State University/Oregon Health Science University College of Pharmacy, Corvallis, Ore
| | - Andrew A White
- Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; The Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Matthew J Greenhawt
- Food Challenge and Research Unit Section of Allergy and Immunology, Children's Hospital Colorado University of Colorado School of Medicine, Aurora, Colo
| | - Caroline C Horner
- Department of Pediatrics, Division of Allergy Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla; James A. Haley Veterans Affairs Hospital, Tampa, Fla
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee Health Science Center, Memphis, Tenn
| | - John Oppenheimer
- Division of Allergy, Rutgers New Jersey Medical School, Rutgers, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio
| | - Dana Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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3
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Essien F, Patterson S, Estrada F, Wall T, Madden J, McGarvey M. ‘TAVR Infected Pseudomonas Endocarditis’: a case
report. Ther Adv Infect Dis 2022; 9:20499361221138459. [PMCID: PMC9716447 DOI: 10.1177/20499361221138459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/26/2022] [Indexed: 12/03/2022] Open
Abstract
Pseudomonas aeruginosa (P. aeruginosa) rarely
causes infective endocarditis (IE), previously reported for approximately 3% of
all patients with IE.1 Most commonly, the infection occurs in
intravenous drug users (IVDU) as right-sided endocarditis, noting presentations
of P. aeruginosa IE without history of intravenous drug to
be extremely rare, finding only a few cases reported in the literature. However
there are increasing reports of cardiovascular implantable electronic
device–related and prosthetic heart valve infections caused by this pathogen in
non-IVDUs.2 This report will focus on the clinical presentation,
management, and outcome of P. aeruginosa endocarditis in an
89-year-old patient with a transcatheter aortic valve replacement (TAVR).
Medical management was pursued due to the patient’s underlying comorbidities.
Long-term suppressive antibiotic therapy with delafloxacin was successful in
maintaining negative blood cultures, despite an allergy to levofloxacin and
ciprofloxacin.
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Affiliation(s)
| | - Shane Patterson
- Division of Infectious Disease, Department of
Internal Medicine, David Grant Medical Center, Travis Air Force Base, Travis
AFB, CA, USA
| | - Fernando Estrada
- Department of Pharmacy, David Grant Medical
Center, Travis Air Force Base, Travis AFB, CA, USA
| | - Timothy Wall
- Department of Internal Medicine, David Grant
Medical Center, Travis Air Force Base, Travis AFB, CA, USA
| | - John Madden
- Department of Radiology, David Grant Medical
Center, Travis Air Force Base, Travis AFB, CA, USA
| | - Michael McGarvey
- Division of Cardiology, Department of Internal
Medicine, David Grant Medical Center, Travis Air Force Base, Travis AFB, CA,
USA
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4
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Azimi SF, Mainella V, Jeffres MN. Immediate hypersensitivity to fluoroquinolones: a cohort assessing cross-reactivity. Open Forum Infect Dis 2022; 9:ofac106. [PMID: 35355888 PMCID: PMC8962755 DOI: 10.1093/ofid/ofac106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/01/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Fluoroquinolones are the second-most prescribed antimicrobial and are frequently associated with causing hypersensitivity reactions. Existing evidence regarding cross-reactivity of fluoroquinolones is limited, offering clinicians little guidance in understanding the implications of selecting an in-class alternative among patients with histories of allergic reactions to fluoroquinolones. The aim of this study was to compare the frequency of immediate hypersensitivity reactions to either ciprofloxacin, levofloxacin, and/or moxifloxacin among patients with a history of immediate hypersensitivity to a different fluoroquinolone.
Methods
This retrospective chart review included adult patients with a history of an immediate hypersensitivity reaction to ciprofloxacin, levofloxacin, and/or moxifloxacin and a documented prescription for a different fluoroquinolone. The primary outcome was documentation of a hypersensitivity reaction upon second fluoroquinolone exposure.
Results
A total of 321 cases met inclusion criteria. Of these cases, 2.5% experienced an immediate hypersensitivity reaction after second fluoroquinolone exposure to ciprofloxacin, levofloxacin, and/or moxifloxacin. Within the ciprofloxacin, levofloxacin, and moxifloxacin index allergy cohorts, the frequency of cross-reactivity were 2.7%, 2.2%, and 5.3%, respectively.
Conclusion
Our data suggest that patients with a history of immediate hypersensitivity reaction to ciprofloxacin, levofloxacin, and/or moxifloxacin are at low risk of experiencing a cross-reaction when exposed to a different fluoroquinolone. Avoidance of all fluoroquinolones in this patient population may not be warranted.
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Affiliation(s)
- Sara F Azimi
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Vincent Mainella
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Meghan N Jeffres
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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5
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Gelincik A, Demir S. Hypersensitivity Reactions to Non-Beta Lactam Antibiotics. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Doña I, Pérez-Sánchez N, Salas M, Barrionuevo E, Ruiz-San Francisco A, Hernández Fernández de Rojas D, Martí-Garrido J, Andreu-Ros I, López-Salgueiro R, Moreno E, Torres MJ. Clinical Characterization and Diagnostic Approaches for Patients Reporting Hypersensitivity Reactions to Quinolones. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2707-2714.e2. [PMID: 32376487 DOI: 10.1016/j.jaip.2020.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Inmaculada Doña
- 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.
| | - Natalia Pérez-Sánchez
- 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
| | - María Salas
- 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
| | - Esther Barrionuevo
- 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
| | | | - Dolores Hernández Fernández de Rojas
- 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
| | - Jaume Martí-Garrido
- Department of Allergy, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Inmaculada Andreu-Ros
- Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica deValència, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, Valencia, Spain
| | - Ramón López-Salgueiro
- Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica deValència, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, Valencia, Spain
| | - Esther Moreno
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain; Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - María José Torres
- 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
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7
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McGee EU, Samuel E, Boronea B, Dillard N, Milby MN, Lewis SJ. Quinolone Allergy. PHARMACY 2019; 7:pharmacy7030097. [PMID: 31330937 PMCID: PMC6789783 DOI: 10.3390/pharmacy7030097] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/10/2023] Open
Abstract
Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. Although the incidence of quinolone allergy is still lower than beta-lactams, it has been increasingly reported in recent decades, most likely from its expanded use and the introduction of moxifloxacin. Thorough patient history remains essential in the evaluation of quinolone allergy. Many diagnostic tools have been investigated, but skin tests can yield false-positive results and in vitro tests have not been validated. The drug provocation test is considered the test of choice to confirm a quinolone allergy but is not without risk. Evidence regarding cross-reactivity among the quinolones is limited and conflicting. Quinolone allergy can be manifested either as an immediate or delayed reaction, but is not uniform across the class, with moxifloxacin posing the highest risk of anaphylaxis. Quinolone should be discontinued when an allergic reaction occurs and avoided in future scenarios, but desensitization may be warranted if no alternatives are available.
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Affiliation(s)
- Edoabasi U McGee
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Essie Samuel
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Bernadett Boronea
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Nakoasha Dillard
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Madison N Milby
- College of Pharmacy, University of Findlay, Findlay, OH 45840, USA
| | - Susan J Lewis
- Department of Pharmacy Practice, College of Pharmacy, University of Findlay, Findlay, OH 45840, USA.
- Mercy Health-St. Anne Hospital, Toledo, OH 43623, USA.
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8
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Anaphylactic shock secondary to oral ofloxacin administration with cross-reactivity to levofloxacin and ciprofloxacin. Therapie 2018; 73:555-556. [DOI: 10.1016/j.therap.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 11/21/2022]
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9
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Sobrino-García M, Gómez-Cardeñosa A, Moreno-Rodilla E, Muñoz-Bellido FJ, Lázaro-Sastre M, Dávila I. A case report of fixed drug eruption caused by several drugs because of cross-reactivity and co-sensitization. Contact Dermatitis 2018; 80:56-57. [DOI: 10.1111/cod.13115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Miriam Sobrino-García
- Department of Allergy; University Hospital of Salamanca; Salamanca Spain
- Institute for Biomedical Research of Salamanca, IBSAL; Salamanca Spain
| | | | - Esther Moreno-Rodilla
- Department of Allergy; University Hospital of Salamanca; Salamanca Spain
- Institute for Biomedical Research of Salamanca, IBSAL; Salamanca Spain
- Department of Biomedical and Diagnostic Sciences; University of Salamanca; Salamanca Spain
| | - Francisco J. Muñoz-Bellido
- Department of Allergy; University Hospital of Salamanca; Salamanca Spain
- Institute for Biomedical Research of Salamanca, IBSAL; Salamanca Spain
- Department of Biomedical and Diagnostic Sciences; University of Salamanca; Salamanca Spain
| | - Milagros Lázaro-Sastre
- Department of Allergy; University Hospital of Salamanca; Salamanca Spain
- Institute for Biomedical Research of Salamanca, IBSAL; Salamanca Spain
- Department of Biomedical and Diagnostic Sciences; University of Salamanca; Salamanca Spain
| | - Ignacio Dávila
- Department of Allergy; University Hospital of Salamanca; Salamanca Spain
- Institute for Biomedical Research of Salamanca, IBSAL; Salamanca Spain
- Department of Biomedical and Diagnostic Sciences; University of Salamanca; Salamanca Spain
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10
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Doña I, Moreno E, Pérez-Sánchez N, Andreu I, Hernández Fernandez de Rojas D, Torres MJ. Update on Quinolone Allergy. Curr Allergy Asthma Rep 2018; 17:56. [PMID: 28752367 DOI: 10.1007/s11882-017-0725-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Quinolones are a group of synthetic antibiotics widely use as first-line treatment for many infections. There has been an increase in the incidence of hypersensitivity reactions to quinolones in recent years, likely due to increased prescription. The purpose of this review is to summarize the clinical pictures, the methods used for diagnosing and the management of allergic reactions to quinolones. RECENT FINDINGS Allergic reactions to quinolones can be immediate or delayed, being anaphylaxis and maculopapular exanthema respectively the most frequent clinical entities. A precise diagnosis is particularly difficult since clinical history is often unreliable, skin tests can induce false-positive results, and commercial in vitro test are not well validated. Therefore, drug provocation testing is considered the gold standard to establish diagnosis, which is not a risk-free procedure. Cross-reactivity between quinolones is difficult to predict due to the small number of patients included in the few published studies. Moreover, hypersensitivity to quinolones has also been associated with beta-lactam and neuromuscular blocking agent allergies, although further studies are needed to understand the underlying mechanisms. Avoidance of the culprit quinolone is indicated in patients with a diagnosis of hypersensitivity to these drugs. When quinolone treatment is the only therapeutic option available, desensitization is necessary. This review summarizes the complex diagnostic approach and management of allergic reactions to quinolones.
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Affiliation(s)
- Inmaculada Doña
- Allergy Unit, Pabellón 6, primera planta, IBIMA Regional University Hospital of Malaga-UMA (Pavillion C, Hospital Civil), Plaza del Hospital Civil, 29009, Malaga, Spain.
| | - Esther Moreno
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Natalia Pérez-Sánchez
- Allergy Unit, Pabellón 6, primera planta, IBIMA Regional University Hospital of Malaga-UMA (Pavillion C, Hospital Civil), Plaza del Hospital Civil, 29009, Malaga, Spain
| | - Inmaculada Andreu
- Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica de València, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain
| | | | - María José Torres
- Allergy Unit, Pabellón 6, primera planta, IBIMA Regional University Hospital of Malaga-UMA (Pavillion C, Hospital Civil), Plaza del Hospital Civil, 29009, Malaga, Spain
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11
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Chang B, Knowles SR, Weber E. Immediate Hypersensitivity to Moxifloxacin with Tolerance to Ciprofloxacin: Report of Three Cases and Review of the Literature. Ann Pharmacother 2017; 44:740-5. [DOI: 10.1345/aph.1m579] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To report 3 cases of immediate hypersensitivity reactions to moxifloxacin in patients who tolerated ciprofloxacin. Case summaries A 71-year-old man, a 44-year-old woman, and a 70-year-old woman with a history of a moxifloxacin reaction developed an immediate hypersensitivity reaction upon oral challenge with moxifloxacin in our Drug Safety Clinic. The reaction was mainly characterized by pruritus and urticaria, although dyspnea and hypotension were noted in the first and second patient, respectively. Two of the patients had negative oral challenge tests with ciprofloxacin and all 3 patients tolerated full treatment courses of oral ciprofloxacin. In all 3 cases, use of the Naranjo probability scale indicated a highly probable adverse drug reaction. Discussion Moxiffoxacin, similar to other fluoroquinolones, can cause immediate hypersensitivity reactions. Previous publications have reported both cross-reactivity and a lack of cross-reactivity among various fluoroquinolones. The 3 patients discussed demonstrated a lack of cross-reactivity between moxifloxacin and ciprofloxacin since they tolerated oral challenge tests and full treatment courses of ciprofloxacin. Moxifloxacin has unique side chains at positions 7 and 8 on its bicyclic ring structure. Antigenic specificity to particular side chains at positions 7 and 8 on the bicyclic ring structure of moxifloxacin may explain this lack of cross-reactivity. Higher reporting rates of anaphylaxis to moxifloxacin compared to other fluoroquinolones may also be related to side chain specificity, although definitive evidence for this is lacking. Conclusions Based on our experience, patients who develop immediate hypersensitivity reactions to moxifloxacin may receive ciprofloxacin therapy in an appropriately monitored setting if they have previously tolerated full treatment courses of ciprofloxacin. Research into whether there is a specific side chain reaction unique to moxifloxacin is warranted.
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Affiliation(s)
- Brenda Chang
- School of Pharmacy, University of Colorado, Denver, CO; now, Primary Care Pharmacist, Department of Family and Community Medicine and Department of Pharmacy, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandra R Knowles
- Drug Safety Clinic and Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto; Department of Medicine, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre
| | - Elizabeth Weber
- Drug Safety Clinic, Sunnybrook Health Sciences Centre; Department of Medicine, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre
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12
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Demir S, Gelincik A, Akdeniz N, Aktas-Cetin E, Olgac M, Unal D, Ertek B, Coskun R, Colakoğlu B, Deniz G, Buyukozturk S. Usefulness of In Vivo and In Vitro Diagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:347-359. [PMID: 28497922 PMCID: PMC5446950 DOI: 10.4168/aair.2017.9.4.347] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 12/21/2022]
Abstract
Purpose Reports evaluating diagnosis and cross reactivity of quinolone hypersensitivity have revealed contradictory results. Furthermore, there are no reports investigating the cross-reactivity between gemifloxacin (GFX) and the others. We aimed to detect the usefulness of diagnostic tests of hypersensitivity reactions to quinolones and to evaluate the cross reactivity between different quinolones including the latest quinolone GFX. Methods We studied 54 patients (mean age 42.31±10.39 years; 47 female) with 57 hypersensitivity reactions due to different quinolones and 10 nonatopic quinolone tolerable control subjects. A detailed clinical history, skin test (ST), and single-blind placebo-controlled drug provocation test (SBPCDPT), as well as basophil activation test (BAT) and lymphocyte transformation test (LTT) were performed with the culprit and alternative quinolones including ciprofloxacin (CFX), moxifloxacin (MFX), levofloxacin (LFX), ofloxacin (OFX), and GFX. Results The majority (75.9%) of the patients reported immediate type reactions to various quinolones. The most common culprit drug was CFX (52.6%) and the most common reaction type was urticaria (26.3%). A quarter of the patients (24.1%) reacted to SBPCDPTs, although their STs were negative; while false ST positivity was 3.5% and ST/SBPCDPTs concordance was only 1.8%. Both BAT and LTT were not found useful in quinolone hypersensitivity. Cross-reactivity was primarily observed between LFX and OFX (50.0%), whereas it was the least between MFX and the others, and in GFX hypersensitive patients the degree of cross-reactivity to the other quinolones was 16.7%. Conclusions These results suggest that STs, BAT, and LTT are not supportive in the diagnosis of a hypersensitivity reaction to quinolone as well as in the prediction of cross-reactivity. Drug provocation tests (DPTs) are necessary to identify both culprit and alternative quinolones.
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Affiliation(s)
- Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nilgun Akdeniz
- Department of Immunology, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Esin Aktas-Cetin
- Department of Immunology, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Muge Olgac
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Derya Unal
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Belkis Ertek
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Raif Coskun
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bahattin Colakoğlu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - Suna Buyukozturk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Benken ST, Nyenhuis SM, Dunne S. Sequential rapid oral desensitization to rifampin and moxifloxacin for the treatment of active mycobacterium tuberculosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:195-197. [PMID: 27838324 DOI: 10.1016/j.jaip.2016.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 09/07/2016] [Accepted: 09/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Scott T Benken
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Ill.
| | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Sean Dunne
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Ill
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Quinolones-induced hypersensitivity reactions. Clin Biochem 2015; 48:716-39. [DOI: 10.1016/j.clinbiochem.2015.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
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15
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Uyttebroek AP, Sabato V, Faber MA, Cop N, Bridts CH, Lapeere H, De Clerck LS, Ebo DG. Basophil activation tests: time for a reconsideration. Expert Rev Clin Immunol 2014; 10:1325-35. [DOI: 10.1586/1744666x.2014.959498] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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IgE and Drug Allergy: Antibody Recognition of ‘Small’ Molecules of Widely Varying Structures and Activities. Antibodies (Basel) 2014. [DOI: 10.3390/antib3010056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Kao L, Rajan J, Roy L, Kavosh E, Khan DA. Adverse reactions during drug challenges: a single US institution's experience. Ann Allergy Asthma Immunol 2012; 110:86-91.e1. [PMID: 23352526 DOI: 10.1016/j.anai.2012.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/02/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Drug challenge is a useful tool when diagnostic testing lacks predictive value for a questionable history of drug allergy. Placebo-controlled drug challenge studies demonstrate that a significant number of patients report purely subjective symptoms to placebo. OBJECTIVE To evaluate the safety and rate of adverse effects when performing drug challenges and to identify predictive factors for occurrences of subjective symptoms during drug challenges. METHODS We performed a 6-year, retrospective medical record review of patients who underwent drug challenges by members of the Allergy and Immunology Division after consultation deemed drug challenges to be appropriate. Statistical analysis was performed to compare the proportion of patients with subjective symptoms based on certain factors, including sex, age, number of listed drug allergies, interval from historical drug reaction to the drug challenge, and types of historical reaction. RESULTS A total of 114 patients underwent 123 drug challenges. Only 1 patient was deemed to have a true positive drug challenge result. Twenty patients reported subjective symptoms during graded challenge, all of which were not deemed a positive challenge. There was a significantly higher proportion of patients who reported subjective symptoms in females, those with a higher number of listed drug allergies, and those whose historical reactions were primarily subjective in nature. CONCLUSION Drug challenges are safe procedures in appropriately selected patients. A number of patients report subjective symptoms during drug challenges. Identifying patients at high risk for subjective symptoms may assist in determining whether placebo-controlled drug challenges should be performed.
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Affiliation(s)
- Leon Kao
- Division of Allergy and Immunology at the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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Nam YH, Kim JE, Kim SH, Jin HJ, Hwang EK, Shin YS, Ye YM, Park HS. Immunologic evaluation of ofloxacin hypersensitivity. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:367-9. [PMID: 23115735 PMCID: PMC3479232 DOI: 10.4168/aair.2012.4.6.367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/23/2012] [Accepted: 05/11/2012] [Indexed: 11/26/2022]
Abstract
Quinolone hypersensitivity, most of which is immediate type, is rare but has increased in recent years. The pathogenic mechanisms underlying immediate reactions are not defined clearly. This study was aimed to observe the clinical characteristics of immediate hypersensitivity to ofloxacin and to investigate the pathogenic mechanism with detection of serum specific IgE to ofloxacin using an enzyme-linked immunoasorbent assay (ELISA). We recruited 5 patients with immediate hypersensitivity reactions to ofloxacin (group I), and as control groups, 5 subjects with ciprofloxacin hypersensitivity (group II) and 20 healthy subjects with no history of drug allergy. Serum specific-IgE to ofloxacin-human serum albumin (HSA) conjugate was detectable in four group I subjects (80%) and three group II subjects (60%). The ELISA inhibition test showed significant inhibition with both ofloxacin-HSA conjugate and free ofloxacin in a dose-dependent manner. As to ciprofloxacin, significant inhibition was noted upon addition of free ciprofloxacin in one subject, while minimal inhibition was noted in the other. We confirmed that an IgE-mediated response is a major pathogenic mechanism of ofloxacin hypersensitivity. Cross reactivity between ofloxacin and ciprofloxacin was noted with individual difference.
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Affiliation(s)
- Young-Hee Nam
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Lavaud F, Mouton C, Ponvert C. Les tests cutanés dans le bilan diagnostique des réactions d’hypersensibilité peranesthésiques. ACTA ACUST UNITED AC 2011; 30:264-79. [DOI: 10.1016/j.annfar.2010.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Aranda A, Mayorga C, Ariza A, Doña I, Rosado A, Blanca-Lopez N, Andreu I, Torres MJ. In vitro evaluation of IgE-mediated hypersensitivity reactions to quinolones. Allergy 2011; 66:247-54. [PMID: 20722637 DOI: 10.1111/j.1398-9995.2010.02460.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypersensitivity IgE-mediated reactions to quinolones are not easy to diagnose, with skin testing inducing false positive results. The aim of the study was to evaluate the in vitro-specific IgE response in patients with immediate allergic reactions to quinolones. METHODS We evaluated 38 patients with confirmed immediate allergic reactions to quinolones. Those with anaphylaxis were considered allergic by clinical history, once other possible causes were ruled out, and those with urticaria by drug provocation. Sepharose-radioimmunoassay (RIA) and basophil activation test (BAT) with ciprofloxacin, moxifloxacin and levofloxacin were performed. RESULTS The quinolones involved were moxifloxacin (N = 24), ciprofloxacin (N = 11) and levofloxacin (N = 3). Sepharose-RIA was positive in 12 cases (31.57%) and BAT in 27 (71.05%). With Sepharose-RIA, 8 (21%) were positive to ciprofloxacin, 7 (18.4%) to moxifloxacin and 7 (18.4%) to levofloxacin. With BAT, 23 (60.5%) were positive to ciprofloxacin, 12 (31.6%) to moxifloxacin and 8 (21%) to levofloxacin. The specificity of the Sepharose-RIA was demonstrated by inhibition tests. To confirm that the BAT results observed were IgE mediated, the PI3K inhibitor wortmannin was used, with this compound inhibiting the BAT when stimulated with anti-IgE and the different quinolones, but not when fMLP was used as the basophil stimulator. Sepharose-RIA and BAT were repeated in positive cases 1 year later, detecting a decrease in all cases, with four becoming negative. CONCLUSION Immediate hypersensitivity reactions to quinolones do occur, with moxifloxacin being the drug most frequently involved. The BAT is a useful method for diagnosing patients. Specific IgE was demonstrated by Sepharose-RIA and inhibition assay.
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Affiliation(s)
- A Aranda
- Research Unit for Allergic Diseases, Malaga, Spain
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Anaphylactoid reaction considered ciprofloxacin related: a case report and literature review. Clin Ther 2010; 32:515-26. [PMID: 20399988 DOI: 10.1016/j.clinthera.2010.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although ciprofloxacin is a generally well-tolerated fluoroquinolone antibiotic, serious and life-threatening adverse events such as anaphylaxis and pulmonary edema have been described with its use. However, there is a lack of data in the scientific literature regarding these events. OBJECTIVES This report describes a case of an anaphylactoid reaction, considered probably ciprofloxacin related, that manifested as angioedema and later as pulmonary edema. This report also summarizes the available scientific evidence regarding the epidemiology, pathogenesis, and outcome of ciprofloxacin-associated anaphylactoid reactions. METHODS Previously reported cases were identified using a search of MEDLINE and EMBASE (years: 1960-June 2009; English-language articles; search terms: ciprofloxacin, anaphylactoid reaction, anaphylaxis, angioedema, and pulmonary edema). The references cited in these articles were examined to identify additional reports. CASE SUMMARY/RESULTS: A 25-year-old healthy white woman with a weight of 65 kg and normal renal function presented with pyelonephritis. She was administered ciprofloxacin 500 mg BID PO and ibuprofen 400 mg q6h PO as needed for pain control. The following day, angioedema and pulmonary edema developed and were thought to be probably associated with ciprofloxacin use (Naranjo adverse drug reaction probability scale score, 6). Ciprofloxacin treatment was discontinued and supportive care with ceftriaxone 1 g/d IV was provided, and the patient recovered after 1 week of hospitalization. The adverse drug reactions associated with the intake of fluoroquinolones most commonly affect the gastrointestinal system, central nervous system, and skin. The literature search identified 64 cases of anaphylactoid reaction considered probably ciprofloxacin related. Forty-two of these cases were described in large studies, with no detailed data reported. Detailed information on the dose of ciprofloxacin, the time period between ciprofloxacin administration and anaphylactoid reaction, clinical manifestations, and outcomes of these reactions was available in 22 cases described in case reports. Twelve of these cases were described in HIV- patients; 10 cases were described in HIV+ patients. All of the patients recovered, with the exception of 2 patients with HIV infection, who died (unknown cause of death in 1 case and toxoplasma encephalitis in the other case). Fourteen patients (including all of the patients with HIV infection) required hospitalization in the intensive care unit. According to the manufacturer of ciprofloxacin, pulmonary edema has been described as an adverse event associated with ciprofloxacin in <1% of treated patients. However, a search of the MEDLINE and EMBASE databases did not identify any documented reports of ciprofloxacin-associated pulmonary edema. CONCLUSIONS The patient described in this case report experienced an anaphylactoid reaction likely associated with ciprofloxacin use. Although anaphylactoid/ anaphylactic reactions are uncommon (<5% of cases) adverse events associated with ciprofloxacin and other fluoroquinolones, clinicians should be aware of this potentially life-threatening event, which might also lead to pulmonary edema even in the setting of normal renal function.
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Sánchez-Morillas L, Rojas Pérez-Ezquerra P, Reaño-Martos M, Laguna-Martínez J, Gómez-Tembleque P. Systemic anaphylaxis caused by moxifloxacin. Allergol Immunopathol (Madr) 2010; 38:226-7. [PMID: 20089346 DOI: 10.1016/j.aller.2009.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/07/2009] [Accepted: 09/10/2009] [Indexed: 11/26/2022]
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Ben Said B, Berard F, Bienvenu J, Nicolas JF, Rozieres A. Usefulness of basophil activation tests for the diagnosis of IgE-mediated allergy to quinolones. Allergy 2010; 65:535-6. [PMID: 19845576 DOI: 10.1111/j.1398-9995.2009.02213.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND/PURPOSE Infrequent toxicities associated with certain drugs and drug classes have recently gained much attention from different health-care perspectives. To protect the patient, continued surveillance of safety and tolerability data is essential. Data from preclinical testing, phase 1-3 trials, and postmarketing surveillance may be used to objectively assess the risks associated with a specific drug or family of compounds. This review summarizes safety and tolerability data for the quinolones. MAIN FINDINGS The most common adverse events associated with the quinolone class involve the gastrointestinal tract (nausea and diarrhea) and central nervous system (CNS) (headache and dizziness). These adverse events are usually mild and do not require discontinuation of therapy. Uncommon and potentially serious quinolone-related adverse events involve the cardiovascular system (rate-corrected electrocardiographic QT interval prolongation), musculoskeletal system (tendinitis and tendon rupture), endocrine system (glucose homeostasis dysregulation), renal system (crystalluria, interstitial nephritis, and acute renal failure), and the CNS (seizures). Severe idiosyncratic adverse events are specific to individual agents that may share some structural congruity, such as the 1-(2,4)-difluorophenyl group shared by trovafloxacin (associated with hepatitis), temafloxacin (associated with hemolytic-uremic syndrome), and tosufloxacin (associated with eosinophilic pneumonitis). Overall, discontinuation rates from clinical trials were <4% for the currently marketed quinolones. Quinolones with higher discontinuation rates, such as trovafloxacin (7.0%) and grepafloxacin (6.4%), are no longer available for general use. CONCLUSIONS The currently marketed quinolones are well tolerated, with safety profiles similar to those of other antimicrobial classes. Although adverse effects are unusual, some, including tendinitis and CNS-related effects, are more common with quinolones than with other antimicrobial classes. Rare adverse effects attributed to some members of the quinolone family (e.g., Torsades de Pointes, hepatotoxicity, and dysglycemias) are more likely to occur in select "susceptible" populations. These adverse events can often be circumvented by avoiding exposure to the specific quinolone. In some cases, the therapeutic value offered by a quinolone may outweigh its potential risks.
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Affiliation(s)
- Robert C Owens
- Division of Infectious Diseases, Department of Clinical Pharmacy Services, Maine Medical Center, Portland, Maine 04102, USA.
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26
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Kothur K, Singh M, Dayal D. Ciprofloxacin-induced anaphylactoid reaction. Eur J Pediatr 2006; 165:573-4. [PMID: 16547727 DOI: 10.1007/s00431-006-0099-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 01/26/2006] [Indexed: 11/25/2022]
Affiliation(s)
- Kavitha Kothur
- Department of Pediatrics, Pediatric Pulmonology Unit, Advanced Pediatric Center, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Schmid DA, Depta JPH, Pichler WJ. T cell-mediated hypersensitivity to quinolones: mechanisms and cross-reactivity. Clin Exp Allergy 2006; 36:59-69. [PMID: 16393267 DOI: 10.1111/j.1365-2222.2006.02402.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Quinolones are widely used, broad spectrum antibiotics that can induce immediate- and delayed-type hypersensitivity reactions, presumably either IgE or T cell mediated, in about 2-3% of treated patients. OBJECTIVE To better understand how T cells interact with quinolones, we analysed six patients with delayed hypersensitivity reactions to ciprofloxacin (CPFX), norfloxacin (NRFX) or moxifloxacin (MXFX). METHODS We confirmed the involvement of T cells in vivo by patch test and in vitro by means of the lymphocyte proliferation test (LTT). The nature of the drug-T cell interaction as well as the cross-reactivity with other quinolones were investigated through the generation and analysis (flow cytometry and proliferation assays) of quinolone-specific T cell clones (TCC). RESULTS The LTT confirmed the involvement of T cells because peripheral blood mononuclear cells (PBMC) mounted an enhanced in vitro proliferative response to CPFX and/or NRFX or MXFX in all patients. Patch tests were positive after 24 and 48 h in three out of the six patients. From two patients, CPFX- and MXFX-specific CD4(+)/CD8(+) T cell receptor (TCR) alphabeta(+) TCC were generated to investigate the nature of the drug-T cell interaction as well as the cross-reactivity with other quinolones. The use of eight different quinolones as antigens (Ag) revealed three patterns of cross-reactivity: clones exclusively reacting with the eliciting drug, clones with a limited cross-reactivity and clones showing a broad cross-reactivity. The TCC recognized quinolones directly without need of processing and without covalent association with the major histocompatability complex (MHC)-peptide complex, as glutaraldehyde-fixed Ag-presenting cells (APC) could present the drug and washing quinolone-pulsed APC removed the drug, abrogating the reactivity of quinolone-specific TCC. CONCLUSION Our data show that T cells are involved in delayed immune reactions to quinolones and that cross-reactivity among the different quinolones is frequent.
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Affiliation(s)
- D A Schmid
- Division of Allergology, Clinic of Rheumatology and Clinical Immunology/Allergology, University of Bern, Bern, Switzerland
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Abstract
Fluoroquinolone antibiotics cause immediate and delayed hypersensitivity reactions, and may also affect internal organs and circulating blood cells. The underlying pathomechanisms are only partly understood. The extent of cross-reactivity among different quinolones depends on the type of clinical manifestation and its underlying mechanism. Despite recent advances, reliable diagnostic tests are still lacking. Recent studies have shown quinolone-specific IgE in vitro in more than 50% of patients with immediate-type reactions and a considerable cross-reactivity with related compounds. In maculopapular drug exanthems from ciprofloxacin, specific T-cell clones were identified, and cross-reactivity to related compounds was detected in approximately 50% of the clones. From re-exposure studies in patients with exanthems, cross-reactivity appears to be lower. Cellular tests such as lymphocyte transformation tests are currently not very useful. For prick and intradermal skin tests, widely divergent nonirritant test concentrations have been recommended. Desensitization may be possible in selected patients.
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Affiliation(s)
- Kathrin Scherer
- Allergy Unit, Department of Dermatology, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland
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Bozkurt B, Karakaya G, Kalyoncu AF. Tolerability of moxifloxacin in patients with antibiotic hypersensitivity. Allergol Immunopathol (Madr) 2005; 33:38-41. [PMID: 15777522 DOI: 10.1157/13070607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Allergic reactions to antibiotics are commonly reported in the clinical practice. The treatment of antibiotic hypersensitivity (AH) consists of suggesting to avoid the offending antibiotics and to use safe alternatives after performing oral provocation tests (OPT). Moxifloxacin is a new fluoroquinolone antibacterial agent with a broad spectrum activity. Allergic reactions to moxifloxacin have rarely been described and therefore it could be tolerated by antibiotic allergic subjects. OBJECTIVES The aim of this survey was to investigate the tolerability of moxifloxacin in antibiotic intolerant patients. MATERIALS AND METHODS A prospective study was conducted in 20 patients diagnosed with AH at our clinic between 1 January 2003 and 31 December 2003. We performed single blind, one day OPT protocol for moxifloxacin with a total dose of 1000 mg. RESULTS The mean age of the patients was 38.05 +/- 14.1 and 17 (85 %) of them were females. There were only two patients with accompanying allergic diseases; one with bronchial asthma and the other with chronic urticaria. The rates of common anamnestic antibiotic hypersensitivities were 50 % with amoxicillin, 40 % with penicillin, 20 % with sulphonamides, respectively. Urticaria (80 %) was the leading reaction appearing after antibiotic ingestion. Seventeen of 20 patients tolerated moxifloxacin at therapeutic doses without any problem. One patient experienced generalized urticaria 4 hours after ingestion of the first dose of the drug, which resolved spontaneously 5 hours after the onset. Another patient experienced tachycardia (heart rate did not exceed beyond 115 per minute) 2.5 hours after ingestion of first dose of the drug, which resolved spontaneously 2 hours after the onset. And a third one developed severe nausea lasting for two hours. CONCLUSION Given the high incidence of hypersensitivity reactions to beta-lactam antibiotics the use of new fluoroquinolone, moxifloxacin might represent a therapeutic alternative.
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Affiliation(s)
- B Bozkurt
- Department of Chest Diseases, Hacettepe University, School of Medicine, Sihhiye Ankara, Turkey.
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Abstract
PURPOSE OF REVIEW Quinolones are potent antibacterial agents that can cause drug hypersensitivity reactions affecting different organs. A better understanding of the underlying mechanism and the level of crossreactivity within different quinolones is needed to handle and prevent these diseases. RECENT FINDINGS The adverse side-effects caused by quinolones are the result of different immunological mechanisms and cause quite different diseases. The development of an assay detecting quinolone-specific IgE revealed specific antibodies in more than 50% of patients with immediate-type reactions, and the majority of sera also reacted with related compounds. In maculopapular drug exanthemas caused by ciprofloxacin, specific T cells could be detected and cloned. They reacted with ciprofloxacin directly, and crossreactivity to related compounds was detected in approximately 50% of the clones. SUMMARY Quinolones can cause drug hypersensitivity reactions by different immunological mechanisms. In-vitro analysis suggests that crossreactivity is common.
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Affiliation(s)
- Paolo Campi
- Allergy Clinic, Nuovo Ospedale San Giovanni di Dio, Florence, Italy.
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Abstract
OBJECTIVE To report a case of anaphylactoid reaction in an HIV-negative patient associated with the administration of intravenous ciprofloxacin. CASE SUMMARY A 79-year-old Armenian man developed an anaphylactoid reaction following a first-time exposure to intravenous ciprofloxacin. This reaction was characterized by severe hypotension, wheezing, tachypnea, tachycardia, and pruritus. The patient had complete recovery once ciprofloxacin treatment was terminated and supportive care was provided. DISCUSSION Fluoroquinolones are important therapeutic agents in the management of infectious diseases and are generally safe and well tolerated. Anaphylactoid and anaphylactic reactions have been documented as adverse effects of ciprofloxacin, ofloxacin, norfloxacin, levofloxacin, and moxifloxacin. To date, >33 cases have been reported with ciprofloxacin, of which at least 10 occurred in HIV-positive patients. In Europe, 15 cases of anaphylactoid reactions to ofloxacin have been reported and, more recently, with moxifloxacin. Since anaphylactoid reactions are potentially life threatening, the administration of fluoroquinolones to patients who have experienced a prior reaction to any of these agents should be avoided, unless tolerance has been confirmed by oral challenge tests. CONCLUSIONS The anaphylactoid reaction in our patient was probably induced by ciprofloxacin as validated by the Naranjo probability scale. Although anaphylactoid/anaphylactic reactions are rare adverse effects of ciprofloxacin and other fluoroquinolones, clinicians should be aware of this potentially fatal event.
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Affiliation(s)
- Dora Y Ho
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
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González-Mancebo E, Cuevas M, González González E, Lara Cátedra C, Dolores Alonso M. Simultaneous drug allergies. Allergy 2002; 57:963-4. [PMID: 12269953 DOI: 10.1034/j.1398-9995.2002.23832_8.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- E González-Mancebo
- Fundación Hospital Alcorcón, Unidad de Alergia, C/ Budapest, 1, 28922 Alcorcón (Madrid), Spain.
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Erdem G, Staat MA, Connelly BL, Assa'ad A. Anaphylactic reaction to ciprofloxacin in a toddler: successful desensitization. Pediatr Infect Dis J 1999; 18:563-4. [PMID: 10391195 DOI: 10.1097/00006454-199906000-00022] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Erdem
- Division of Infectious Diseases, Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Affiliation(s)
- J C Gea-Banacloche
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1888, USA
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Affiliation(s)
- R R Lantner
- Department of Pediatrics, Loyola University Medical Center, Maywood, Ill, USA
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Kurata M, Kasuga Y, Nanba E, Nakamura H, Asano T, Haruta K. Flush induced by fluoroquinolones in canine skin. Inflamm Res 1995; 44:461-5. [PMID: 8597878 DOI: 10.1007/bf01837910] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The flush induced by two fluoroquinolone antibacterial agents, balofloxacin and ofloxacin, was studied in beagle dogs. Intradermal injection of the fluoroquinolones at concentrations above 10(-5) M produced a localized flushed area. The flush responses to fluoroquinolones were inhibited by co-administration with H2-antagonist(s) (ranitidine or cimetidine), but not with H1-antagonist(s) (mepyramine or chlorpheniramine). Similar inhibitory effects of these H2-antagonists were observed for the response to histamine. The flush responses to fluoroquinolones were inhibited by a local pretreatment with compound 48/80 administered to deplete the local stores of mast cell-bound histamine. When the fluoroquinolones were orally administered at a dose of 400 mg/kg, the concentration of histamine in plasma was increased, being accompanied by systemic erythema. These results indicate that the flush induced by fluoroquinolones is mediated by histamine release from canine cutaneous mast cells and H2-receptor stimulation.
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Affiliation(s)
- M Kurata
- Toxicology Laboratory, Chugai Pharmaceutical Co. Ltd., Nagano, Japan
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Lozano Ayllón M, Gómez Martinez M, Mosquera MR, Laguna Martinez JJ, Orta Martiartu M, Fernández de Miguel C. Fixed eruption caused by ciprofloxacin without cross-sensitivity to norfloxacin. Allergy 1995; 50:598-9. [PMID: 8588694 DOI: 10.1111/j.1398-9995.1995.tb01206.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report the case of a female patient who presented fixed exanthema following administration of ciprofloxacin. To our knowledge, only one case of fixed exanthema in response to this agent has appeared in the literature, and it was associated with cross-sensitivity to norfloxacin.
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