The Role of in Vivo Tests in the Diagnosis of Hypersensitivity Reactions Due to Quinolones and Their Importance in Cross-Reactions
The Role of in Vivo Tests in the Diagnosis of Hypersensitivity Reactions Due to Quinolones and Their Importance in Cross-Reactions
Objectives: There are conflicting results regarding the sensitivity of skin tests and cross-reactions between quinolones in quinolone allergy. In our study, we aimed to evaluate the results of skin tests and provocation tests performed with quinolones and to investigate the value of these tests in the diagnosis of hypersensitivity reactions due to quinolones and their usefulness in detecting possible cross-reactions between quinolones. Materials and Methods: We analyzed the file records of the patients who applied to our clinic for the reason of antibiotic drug allergy and who underwent diagnostic or alternative in vivo diagnostic tests with quinolone group drugs between January 2006 and September 2020. We recorded and evaluated the results of these cases with demographic characteristics such as age, gender, atopy history, concomitant allergic diseases, suspected antibiotic(s), allergic reaction type and time of occurrence, skin tests for diagnosis, and drug provocation tests. Results: The study included 715 patients, 73.56% of whom were women. Of the patients, 92.72% had a history of early-type drug allergic reactions. Skin tests had been applied to 219 patients. Of the 119 skin tests performed for diagnostic purposes, 48 were positive. A provocation test was performed in 31 of these patients whose skin test was found to be sensitive; 27 of them were negative. In 47 patients, 83 safe cross-over alternative drugs were obtained through provocation tests. Conclusion: Provocation tests are necessary for the diagnosis of quinolone hypersensitivity reaction and in the evaluation of cross-reactivity. Before provocation tests, evaluation should be made with skin tests.
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- 1. Pham TD, Ziora ZM, Blaskovich MA. Quinolone antibiotics. Medchemcomm. 2019;10(10):1719-39.
- 2. Doña I, Moreno E, Pérez-Sánchez N, Andreu I, Hernández Fernandez de Rojas D, Torres MJ. Update on quinolone allergy. Current allergy and asthma reports. 2017;17(8):1-10.
- 3. McGee EU, Samuel E, Boronea B, Dillard N, Milby MN, Lewis SJ. Quinolone allergy. Pharmacy. 2019;7(3):97.
- 4. Díaz ID. Clinical practice guidelines for diagnosis and management of hypersensitivity reactions to quinolones. J Investig Allergol Clin Immunol. 2021;31.
- 5. Diaz MV, Labairu TL, del Pozo Gil M, Sarramian AB, Mahave IG. In vivo diagnostic tests in adverse reactions to quinolones. Journal of Investigational Allergology and Clinical Immunology. 2007;17(6):393.
- 6. Manfredi M, Severino M, Testi S, et al. Detection of specific IgE to quinolones. Journal of allergy and clinical immunology. 2004;113(1):155-60.
- 7. Aranda A, Mayorga C, Ariza A, et al. In vitro evaluation of IgE mediated hypersensitivity reactions to quinolones. Allergy. 2011;66(2):247-54.
- 8. Demoly P, Adkinson NF, Brockow K, et al. International Con sensus on drug allergy. Allergy. 2014;69(4):420-37.
- 9. Dykewicz MS, Lam JK. Drug hypersensitivity reactions. Medical Clinics. 2020;104(1):109-28.
- 10. Çelik G, Karakaya G, Öztürk A, et al. Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey. Allergologia et Immunopathologia. 2014;42(6):573-9.
- 11. Doña I, Blanca-Lopez N, Torres M, et al. 7 Drug Hypersensitivity Reactions: Response Patterns, Drug Involved, and Temporal Variations in a Large Series of Patients. Journal of Investigational Allergology and Clinical Immunology. 2012;22(5):363.
- 12. Doña I, Pérez-Sánchez N, Salas M, et al. Clinical characterization and diagnostic approaches for patients reporting hypersensitivity reactions to quinolones. The Journal of Allergy and Clinical Immunology: In Practice. 2020;8(8):2707-14. e2.
- 13. Uyttebroek AP, Sabato V, Bridts CH, De Clerck LS, Ebo DG. Moxifloxacin hypersensitivity: uselessness of skin testing. The Journal of Allergy and Clinical Immunology: In Practice. 2015;3(3):443-5.
- 14. Perez E, Callero A, Martinez-Tadeo JA, et al. Are skin tests useful in fluoroquinolone hypersensitivity diagnosis? Annals of Allergy, Asthma & Immunology. 2013;111(5):423-5.
- 15. Seitz C, Bröcker E, Trautmann A. Diagnostic testing in suspected fluoroquinolone hypersensitivity. Clinical & Experimental Allergy. 2009;39(11):1738-45.
- 16. Demir S, Gelincik A, Akdeniz N, et al. Usefulness of in vivo and in vitro diagnostic tests in the diagnosis of hypersensitivity reactions to quinolones and in the evaluation of cross-reactivity: a comprehensive study including the latest quinolone gemifloxacin. Allergy, asthma & immunology research. 2017;9(4):347-59.
- 17. Lobera T, Audícana M, Alarcón E, Longo N, Navarro B, Muñoz D. Allergy to quinolones: low cross- reactivity to levofloxacin. J Investig Allergol Clin Immunol. 2010;20(7):607-11.
- 18. Davila I, Diez M, Quirce S, Fraj J, De La Hoz B, Lazaro M. Cross reactivity between quinolones: Report of three cases. Allergy. 1993;48(5):388-90.
- 19. Sanchez-Morillas L, Rojas Perez-Ezquerra P, Reano-Martos M, Laguna-Martínez J, Gómez-Tembleque P. Systemic anaphylaxis caused by moxifloxacin. Allergol immunopatol. 2010;38(4):226-7.