Q:

9/4/2013
61 y.o. white female, allergic to sulfa antibiotics who while taking Cipro for a suspected UTI develops an erythematous rash, non-pruritic on day 4. Rash is bright red and covers head, trunk, extremities. Ultimately she gets peeling of fingers and toes. I am concerned that this reaction was erythema multiform minor. My question is whether she needs to avoid all oxyquinalones or just Cipro?

A:

Thank you for your inquiry.

Unfortunately, to the best of my knowledge, there is no answer to your question. I could find no references dealing with this issue that would allow us to come to any definitive conclusion. It would be my opinion that cross-reactivity would be unlikely, but there is no way as best I know to confirm this.

However, because I could not find an answer to your question, I am asking Dr. David Khan, who is coauthor of the Parameters on Drug Reactions, if he is aware of any information which I have not been able to find in this regard. Once we receive Dr. Khan’s response, I will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response to your Ask the Expert inquiry from Dr. Dave Khan.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Dave Khan:
I do agree with you that this is an area we have very little knowledge of. The literature for cross-reactivity for immediate reactions to quinolones is fairly mixed and there is much less information for delayed reactions. I don't think we really know what to tell patients. In our experience we have not found any positive challenges when testing to a different quinolone but we have not done this for any serious cutaneous reactions.

Dave Khan

AAAAI - American Academy of Allergy Asthma & Immunology