Immunologic Evaluation of Ofloxacin Hypersensitivity

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.

Risk factors of anaphylaxis in Korea: Identifying drug-induced anaphylaxis culprits using big data

“…Cefaclor is a second-generation cephalosporin, which was reported as one of the most frequently involved antibiotic drugs in anaphylaxis in Korea and in other countries. [40,41] However, other antibiotics, including penicillins such as amoxicillin, did not show a significant association with the occurrence of anaphylaxis. This may be because an excessive list of drugs were included in the analysis, which could make it difficult to consider drug-drug interactions and perform a suitable regression.…”

An Ofloxacin-Induced Anaphylaxis through an IgG4-Mediated but Not IgE-Mediated Basophil Activation Mechanism

“…The pathogenesis of anaphylaxis caused by ofloxacin is not yet fully understood, as it is not commonly reported. There has been a report demonstrating high serum specific IgE levels to ofloxacin-human serum albumin (HSA) conjugate using enzymelinked immunosorbent assay (ELISA), enzyme-linked immunospecific assay [2]; however, this is the first report to suggest an IgG4-mediated but not IgE-mediated mechanism in a patient with ofloxacin-induced anaphylaxis.…”

“…Ofloxacin-HSA conjugate was conducted to investigate immunologic mechanisms to detect serum specific IgE antibody to ofloxacin-HSA conjugate using ELISA as previously described [2]. When the positive cutoff value was determined from the mean +3 standard deviation absorbance values of 20 nonatopic healthy controls that never experienced any other drug allergy according to medical records, serum specific IgE antibody was not detected in the patient’s serum, while high serum specific IgG4 antibody was detected as shown in Figure 1.…”

“…Another study showed in 30 of 55 (54.5%) patients with immediate reactions to eight quinolones including ofloxacin detected by serum specific IgE [6]. In cases of ofloxacin-induced anaphylaxis, our previous study reported four of five (80%) patients with serum specific IgE to ofloxacin-HSA conjugate using ELISA [2].…”

Ofloxacin Induced Hypersensitivity Reaction

“…However, the mechanism underlying ofloxacin hypersensitivity remains unknown. 3 fluoroquinolones are well tolerated, with most side-effects being mild to moderate. 4 On occasion, serious adverse effects occur.…”