Immediate Hypersensitivity to Fluoroquinolones: 
A Cohort Assessing Cross-Reactivity

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.

A Case of Anaphylactic Shock Due to Levofloxacin Eye Drops Confirmed by a Prick Test

“…The levofloxacin eye drops were marketed in Japan in 2000 for the treatment of ocular infections. In contrast to the relatively high frequency of immediate hypersensitivity when administered orally or intravenously [3], levofloxacin eye drops have been used safely so far.…”

Ciprofloxacin-Induced Anaphylactic Reaction Followed by Negative Provocation Test in Response to Levofloxacin: A Case Report

“…All participants were exposed to a second fluoroquinolone, but only eight participants experienced an immediate hypersensitivity reaction, yielding a cross-reactivity frequency of 2.5%. Only four out of 157 participants with a history of immediate HRs to ciprofloxacin developed an HR with levofloxacin exposure [19]. In addition, according to a case report from Japan, a 26-year-old man developed anaphylactic shock after receiving levofloxacin treatment.…”

Large healthcare system evaluation of postoperative moxifloxacin ophthalmic solution cross-reactivity

“…2,3 Publications on reactions to fluoroquinolone ophthalmic drops are scarce, and most data available focus on systemic administration with rates of cross-reactivity varying from 2.5% to 10%. 4–7…”

“…2,3 Publications on reactions to fluoroquinolone ophthalmic drops are scarce, and most data available focus on systemic administration with rates of cross-reactivity varying from 2.5% to 10%. [4][5][6][7] In an attempt to add to the literature, we aim to evaluate rates of cross-reactivity among patients with a reported fluoroquinolone hypersensitivity reaction who subsequently received moxifloxacin ophthalmic drops postoperatively for cataract removal in a large healthcare system. We report a case series of patients admitted to our health system for cataract removal between February 2013 and July 2021.…”

“…One previous study illustrated the onset of fluoroquinolone cross-reactivity occurs at approximately day 9 of administration. 6,7 The median time from the initial incident fluoroquinolone to moxifloxacin challenge was 6 years (7 months to 7 years). Of note, antibiotic allergies may wane in some patients over time, and this may have occurred in our cohort.…”