Negativity of the Basophil Activation Test in Quinolone Hypersensitivity: A Breakthrough for Provocation Test Decision-Making

Abstract

Background: Quinolone hypersensitivity reactions are being more frequently reported. Skin tests in investigations of patients are known to not be fully reliable. The provocation test thus remains the gold standard in the definitive diagnosis of allergy, despite the risks involved. The aim of this study was to evaluate basophil activation tests (BATs) in the diagnosis of immediate-type reactions to quinolones. Methods: Thirty-four patients who presented an immediate-type hypersensivity reaction less than an hour after quinolone administration were studied. The allergologic workup of these patients consisted of a careful clinical history, a skin test and a BAT with the culprit quinolone. If not contraindicated, and in the case of high probability of a nonallergic reaction, provocation tests were performed to assess the nonimmunologic nature of the hypersensitivity. Results: Among the 34 patients studied, 17 (50%) presented a negative BAT to the suspected quinolone, while the other 17 (50%) patients presented a positive BAT for quinolone at the time of their reaction. Among the 17 patients with negative BATs, 15 (2 of whom had had positive skin tests) had quinolone successfully reintroduced. Conclusions: Our report suggests that the BAT, if negative for the culprit quinolone, is a valuable tool in the decision whether or not to perform provocation tests in patients with a history of immediate-type reaction to quinolones, in order to exclude an allergic reaction.

A Case of Anaphylaxis Following Administration of Garenoxacin Mesylate Hydrate

“…Immediate-type hypersensitivity reactions to quinolone often occur within 1 h after the intake of quinolones [8]. The time to onset of reaction in our case was rather delayed.…”

“…Although statistical data of the Pharmaceutical Affairs Act in Japan in 2008 indicates 21 cases of anaphylaxis due to GRN, [6] our case is the first report describing precise clicial history of anaphylaxis related to GRN. Evaluations of prick tests in quinolones are controversial because prick tests in quinolones are known to display both false negative [7] and false positive results [8]. Rouzaire et al performed BATs in 34 patients who were being evaluated for quinolone hypersensitivity.…”

“…Subsequently, they were able to successfully reintroduce quinolones in 15 of the 17 patients. They stated that 13 patients with positivite results for both BAT and skin test had high probability of allergic hypersensitivity [8]. However, reliability of BAT in quinolone is still not validated and its sensitivity has been reported 36.0-79.2% [9].…”

In vitro Diagnosis of Immediate Drug Hypersensitivity: Should We Go with the Flow?

“…This suggests that fluoroquinolones might trigger basophil activation that cannot readily be depicted by traditional CD63-based assays. Alternatively, the more consistent results with CD203c upregulation [28,30] could indicate that mediator release in response to quinolones could result from alternative degranulation pathways [62,63]. …”

“…As displayed in tables, the technique has mainly been applied to document allergy to NMBAs (table 1) [8,9,10,11,12,13,14,15,16], antibiotics like β-lactam antibiotics and quinolones (table 2) [17,18,19,20,21,22,23,24,25,26,27,28,29,30], aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs; table 3) [31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], and iodinated radiocontrast media (RCM; table 4) [46,47,48]. In general, the sensitivity of the assay varies between 50 and 60%, whereas specificity easily attains 80%, except for quinolones and NSAIDs (see below).…”