Hypersensitivity reactions to quinolones

Blanca‐López, Natalia; Andreu, Inmaculada; Jaén, María José Torres

doi:10.1097/aci.0b013e3283489bc3

Cited by 64 publications

(49 citation statements)

References 31 publications

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“…Vancomycin is the second most common antibiotic involved, although reactions are almost always due to a non-immunological mechanism [67]. Quinolones are the third most important group with an increase incidence [68]. Finally, other potentially important antibiotics include gentamicin, metronidazole and tobramycin, mainly used in abdominal surgery [69].…”

Section: A) Drugsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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Section: A) Drugsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

View full text Add to dashboard Cite

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“…In parallel to the increased quinolone consumption, the frequency of hypersensitivity reactions has significantly increased over the past decade and quinolones represent the most frequent reason for hypersensitivity reactions among non beta-lactam antibiotics 4. Quinolones induce hypersensitivity reactions primarily by immunoglobulin E (IgE) and T cell-mediated mechanisms 567. The most common hypersensitivity reaction types are urticaria and anaphylaxis 5678.…”

Section: Introductionmentioning

confidence: 99%

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Demir

Gelincik

Akdeniz

et al. 2017

Allergy Asthma Immunol Res

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PurposeReports 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.MethodsWe 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.ResultsThe 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%.ConclusionsThese 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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“…The diagnosis of a patient's allergy to quinolones is based on clinical history, skin prick test, intradermal test and oral challenge. The usefulness of the skin tests is questionable due to the false-negative or false-positive test results and the oral challenge test is more diagnostic [6,13].…”

Section: Discussionmentioning

confidence: 99%

Ofloxacin Induced Angioedema: A Rare Adverse Drug Reaction

Rawal

Yadav

Kumar

et al. 2016

JCDR

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A 24-year-old Indian female arrived in emergency department with complaints of acute swelling of the lower lip [Table/ Fig-1] with ulceration [Table/ Fig-2], causing pain and discomfort. She gave a history of loose stools and vomiting for two days, for which she was prescribed tablet Ofloxacin 200mg twice daily along with advice to take plenty of oral fluids, by a local general practitioner. The patient took one tablet of Ofloxacin and the frequency of the loose stools gradually decreased, but within few hours of ingestion of the antibiotic, she developed swelling of her lower lip which was increasing in its size along with discomfort and pain. There was no history of breathing difficulty, rashes and itching. Her examination showed normal vitals: pulse rate 74bpm, Blood pressure 120/70mmHg, chest bilaterally clear and normal cardiac rhythms. Her complete haemogram, renal and liver function tests were normal. She didn't have any known past history of allergic reaction to medicine or food, or history of any allergic condition like dermatitis or asthma. Considering the given history (with no history of any other medicine intake), clinical examination and the normal laboratory findings, an empirical diagnosis of Ofloxacin induced hypersensitivity (angioedema) was made and the patient was advised to stop the offending drug-Ofloxacin. Naranjo's causality assessment scale graded the reaction as 'probable'.She was given intravenous Methylprednisolone 40mg stat, Pheniramine maleate (Avil) 25mg intravenous stat and advised tablet Levocetirizine 10mg once daily for five days. After achieving symptomatic relief she was asked to follow-up in outpatient department. The patient showed recovery and the swelling and pain, reduced the next day. A written and informed consent was obtained from the patient for using the clinical images and the details of the case. The Adverse Drug Reaction (ADR) to a commonly prescribed anti-microbial can pose a major public health problem. The authors report a rare case of 24-year-old young lady who presented with angioedema of lips after ingestion of Ofloxacin, prescribed to her for treatment of loose motions. Fluoroquinolones are widely prescribed antibiotics for various disease conditions. The history, clinical examination and normal laboratory parameters led to the diagnosis of ofloxacin induced hypersensitivity reaction and the patient was successfully treated with corticosteroids and antihistamines. The hypersensitivity reactions to fluoroquinolones are rare with an incidence of 0.4% to 2%. The pharmacovigilance program and self-reporting of all the ADR's by the health care workers can help in ensuring the judicious use of the drug, drug safety and thus decrease the associated morbidity and mortality.

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Hypersensitivity reactions to quinolones

Abstract: Over the past decade the number of hypersensitivity reactions to quinolones has increased. These reactions can be severe and diagnosis difficult to confirm. Although new in-vitro tests hold promise, drug provocation testing remains the most frequently used and reliable diagnostic method.

Cited by 64 publications

References 31 publications

Practical Guidelines for Perioperative Hypersensitivity Reactions

Practical Guidelines for Perioperative Hypersensitivity Reactions

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Ofloxacin Induced Angioedema: A Rare Adverse Drug Reaction

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