Update on Quinolone Allergy

Doña, Inmaculada; Moreno, Esther; Pérez‐Sánchez, Natalia; Andreu, Inmaculada; Hernández, Dolores; Torres, Marı́a José

doi:10.1007/s11882-017-0725-y

Cited by 38 publications

(46 citation statements)

References 66 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Wedi

Gehring

Kapp

2020

Allergy

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Background Mas‐related G protein‐coupled receptor X2 (MRGPRX2) is regarded as a mast cell‐specific receptor mediating non–IgE‐dependent activation. We aimed to investigate whether human basophils and eosinophils express functional MRGPRX2. Methods Flow cytometry, immunocytochemistry, immunofluorescence, Western blot, and RT‐PCR were performed in highly purified peripheral blood basophils and eosinophils of atopic and nonatopic donors. To assess functional activity, fluorescent avidin‐based degranulation assay, calcium mobilization, cytokine production in supernatants, assessment of viability/apoptosis, and tricolor granulocyte activation test were used. Results MRGPRX2 was significantly expressed by basophils and eosinophils but not neutrophils. Functional capacity was shown by anti‐MRGPRX2 mAb‐induced calcium influx and concentration‐dependent induction of degranulation. Sequential stimulation in the calcium mobilization assay gave no evidence for desensitization or receptor internalization. Anti‐MRGPRX2 mAb significantly promoted survival. Inhibition of apoptosis could be due to released IL‐3, IL‐5, and GM‐CSF found in supernatants. Short‐term incubation with IL‐3 dose‐dependently upregulated MRGPRX2 expression in both, stimulation for 24 hours with anti‐IgE, C5a, fMLP, and IL‐3 in basophils and by IL‐3, IL‐5, and IL‐33 in eosinophils. Among known mast cell MRGPRX2 agonists ciprofloxacin but not PMX‐53 was functional on basophils and eosinophils. In basophils of allergic subjects, tricolor granulocyte activation test using grass pollen demonstrated MRGPRX2 upregulation associated with degranulation and CD63 expression. Conclusion Unraveling the regulation and signaling mechanisms of MRGPRX2 on basophils and eosinophils might enable the development of new therapeutic strategies to prevent or inhibit allergic and nonallergic hypersensitivity. Moreover, addressing MRGPRX2 might have potential for diagnostic purposes in (drug) hypersensitivity.

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Section: Discussionmentioning

confidence: 99%

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

Wedi

Gehring

Kapp

2020

Allergy

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“…A receptor on murine mast cells, Mrgprb2, the orthologue of the human G-protein-coupled receptor MRGPRX2, was necessary for certain non-IgE-mediated drug reactions. [5] Vancomycin and fluoroquinolones are the most commonly recognised mast-cell activators that cause non-IgE-mediated reactions to antibiotics, [8] , [9] thus producing a reaction with an immunological phenotype, but without immunological memory. Typically, non-IgE reactions have less cardiovascular symptomatology and hypotension, but are otherwise not easily distinguished from IgE-mediated allergy (table).…”

Section: Classification Presentation and Mechanismmentioning

confidence: 99%

Antibiotic allergy

et al. 2019

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Antibiotics are the commonest cause of life-threatening immune-mediated drug reactions that are considered off-target, including anaphylaxis, and organ-specific and severe cutaneous adverse reactions. However, many antibiotic reactions documented as allergies were unknown or not remembered by the patient, cutaneous reactions unrelated to drug hypersensitivity, drug-infection interactions, or drug intolerances. Although such reactions pose negligible risk to patients, they currently represent a global threat to public health. Antibiotic allergy labels result in displacement of first-line therapies for antibiotic prophylaxis and treatment. A penicillin allergy label, in particular, is associated with increased use of broad-spectrum and non-β-lactam antibiotics, which results in increased adverse events and antibiotic resistance. Most patients labelled as allergic to penicillins are not allergic when appropriately stratified for risk, tested, and re-challenged. Given the public health importance of penicillin allergy, this Review provides a global update on antibiotic allergy epidemiology, classification, mechanisms, and management.

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“…Most hypersensitivity reactions to quinolones are immediate reactions, which are IgE-mediated. Importantly, reactions are severe for 70% of cases [22,23]. An immediate hypersensitivity reaction to Gemifloxacin has been reported [24].…”

Section: Discussionmentioning

confidence: 99%

Female Asthmatic Patients Have Higher Risk to Develop Gemifloxacin-Associated Skin Rash, Highlighting Unique Delayed Onset Characteristics

Wei

Shen

et al. 2019

Antibiotics

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Gemifloxacin is a common oral antibiotic for lower respiratory tract infection worldwide. We noticed an uncommon delayed onset skin rash in patients who received Gemifloxacin. Therefore, we retrospectively reviewed all patients who received Gemifloxacin from 1 January 2011 to 31 May 2016 in a university-affiliated hospital in Taiwan. A total of 1358 patients were enrolled, of whom 36 (2.65%) had skin eruptions. The female patients had a significantly higher odds ratio (OR) 2.24 (95% confidence interval (CI) 1.11–4.53, p = 0.021) of having skin eruptions. A history of asthma was also a significant risk factor (OR 2.04, 95% CI = 1.01–4.14, p = 0.043). Female asthmatic patients had the highest risk of skin eruptions (10/129, 7.2%) with an adjusted OR up to 4.45 (95% CI = 1.81–10.93, p < 0.001) compared to male and non-asthmatic patients. Of note, up to 58.3% (21/36) of the patients experienced a skin rash after they had completed and stopped Gemifloxacin. The median onset time was on the second day (ranging one to five days) after completing treatment. We reported that female asthmatic patients have the highest risk of Gemifloxacin-associated skin eruptions in Asia and that they highlighted a unique delayed onset skin rash.

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Update on Quinolone Allergy

Cited by 38 publications

References 66 publications

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

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

Antibiotic allergy

Female Asthmatic Patients Have Higher Risk to Develop Gemifloxacin-Associated Skin Rash, Highlighting Unique Delayed Onset Characteristics

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