Clinical characteristics and diagnosis of patients reporting hypersensitivity reactions to quinolones

Published online: May 3, 2020

Quinolones are the third most common drug associated with hypersensitivity, and the second most frequent drug inducing severe anaphylaxis. Moreover, hypersensitivity to quinolones appears in a number of patients previously diagnosed as allergic to beta-lactams, which drastically reduces available therapeutic options. Despite the important health problem represented by hypersensitivity to quinolones, no large-scale study of patients suffering from them exists. The accurate diagnosis of quinolone-induced hypersensitivity is an important issue. However, the optimal diagnostic approach remains a controversial topic as the value of skin tests (STs) is uncertain, in vitro tests such as basophil activation test (BAT) have shown contradictory findings, and the drug provocation test (DPT) remains the gold standard, but is not free of risk.

In a recent article published by The Journal of Allergy and Clinical Immunology: In Practice, Doña et al describe the clinical characteristics of the largest series of hypersensitivity to quinolones published to date and present methods for their diagnosis. In addition, a logistic regression analysis establishes the characteristics associated with the diagnosis of hypersensitivity or tolerance to quinolones.

The study found that most reactions occurred within 1 hour after the quinolone intake (immediate reactions, IRs), with anaphylaxis being the symptom most frequently reported and moxifloxacin the most common culprit. STs showed a low sensitivity, although it was higher for severe reactions and when levofloxacin and ciprofloxacin were the quinolones involved. BAT was found to be useful for the diagnosis of patients reporting IRs, giving a higher percentage of positive results than STs. DPT was useful to find safe alternative quinolones. The risk of confirmed hypersensitivity was higher for cases who reported moxifloxacin-induced anaphylaxis and for those reporting IRs, compared with cases who reported other symptoms induced by other quinolones and reactions longer than 1 hour after drug intake.

This study shows relevant differences in clinical characteristics comparing cases confirmed as hypersensitive to quinolones with cases tolerant to these drugs, highlighting the importance of a detailed clinical history as an initial approach for diagnosis. Based on the data obtained, Doña et al propose an algorithm for the diagnosis of quinolone-induced hypersensitivity that includes STs, BAT, and DPT as necessary.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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