Quinolone Allergy

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.

The pseudoallergen receptor MRGPRX2 on peripheral blood basophils and eosinophils: Expression and function

“…Immediate type reactions to quinolones such as ciprofloxacin are suggested to be IgE‐mediated but this has never been clearly established . Skin tests often induce false‐positive results, probably because of the capacity to directly induce histamine release, and commercial in vitro test are not well validated . Most studies diagnosed immediate hypersensitivity solely by positive skin test and/or positive basophil activation test, but did not prove this by drug provocation test.…”

“…43 Skin tests often induce false-positive results, probably because of the capacity to directly induce histamine release, and commercial in vitro test are not well validated. 46,47 Most studies diagnosed immediate hypersensitivity solely by positive skin test and/or positive basophil activation test, but did not prove this by drug provocation test. Looking at recent more reliable data using the gold standard drug provocation, basophil activation test was not regarded as useful diagnostic tool.…”

Quinolone immediate hypersensitivity due to topical ophthalmic preparations: a case report and review of literature

“…They are usually prescribed based on broad indications of systemic and local infections. Although considered to be generally well‐tolerated, quinolones are the second‐most common antimicrobes class associated with immediate hypersensitivity reactions 2 . Topical ophthalmic preparations reportedly can cause immediate (type I) hypersensitivity reactions such as urticaria, edema, and anaphylaxis 3–6 ; however, only three cases of type I hypersensitivity reactions induced by quinolone‐containing eyedrop solution has been reported, 4,6,7 in contrast to many reported cases due to systemic administration of the same agent.…”

Unlocking the Non-IgE-Mediated Pseudo-Allergic Reaction Puzzle with Mas-Related G-Protein Coupled Receptor Member X2 (MRGPRX2)

“…Several non-peptide chemical compounds such as experimental drug compound 48/80, several classes of FDA-approved drugs, and natural compounds have been reported to cause allergic reactions via MRGPRX2-mediated MC activation ( Table 1 ). The FDA-approved drugs include fluoroquinolone antibiotics, neuromuscular blocking agents (NMBAs), opiates, and antidepressants [ 143 ].…”