Update on Quinolone Allergy
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Purpose of Review
Quinolones are a group of synthetic antibiotics widely use as first-line treatment for many infections. There has been an increase in the incidence of hypersensitivity reactions to quinolones in recent years, likely due to increased prescription. The purpose of this review is to summarize the clinical pictures, the methods used for diagnosing and the management of allergic reactions to quinolones.
Allergic reactions to quinolones can be immediate or delayed, being anaphylaxis and maculopapular exanthema respectively the most frequent clinical entities. A precise diagnosis is particularly difficult since clinical history is often unreliable, skin tests can induce false-positive results, and commercial in vitro test are not well validated. Therefore, drug provocation testing is considered the gold standard to establish diagnosis, which is not a risk-free procedure. Cross-reactivity between quinolones is difficult to predict due to the small number of patients included in the few published studies. Moreover, hypersensitivity to quinolones has also been associated with beta-lactam and neuromuscular blocking agent allergies, although further studies are needed to understand the underlying mechanisms. Avoidance of the culprit quinolone is indicated in patients with a diagnosis of hypersensitivity to these drugs. When quinolone treatment is the only therapeutic option available, desensitization is necessary.
This review summarizes the complex diagnostic approach and management of allergic reactions to quinolones.
KeywordsAnaphylaxis Basophil activation test Drug provocation test Maculopapular exanthema Quinolone Skin test
Acute generalized exanthematous pustulosis
Basophil activation test
Drug provocation test
Enzyme-linked immunosorbent assay
Fixed drug eruption
Neuromuscular blocking agent
Skin prick test
Toxic epidermal necrolysis
Acknowledgements and Authors’ Contributions
We thank James R. Perkins for his help with the English language version of this manuscript. MJT and ID compiled the entire manuscript; MJT contributed to the introduction, management, and desensitization and conclusion sections; IA contributed to the classification and chemical structure and in vitro tests sections; EM contributed to the clinical reactions immediate and delayed reactions, clinical history and skin tests sections; ID contributed to the epidemiology and risk factors; drug provocation test and cross-reactivity sections. All authors read and approved the final manuscript.
The present study has been supported by Institute of Health “Carlos III” of the Ministry of Economy and Competitiveness (grants cofunded by European Regional Development Fund (ERDF): RETIC ARADYAL RD16/0006/0001. I Doña holds a Juan Rodes research contract (JR15/00036) from the Carlos III National Health Institute, Spanish Ministry of Economy and Competitiveness (grants cofounded by European Social Fund, ESF).
Compliance with Ethical Standards
Conflict of Interest
None of the authors have any conflict of interest, nor have they received any money for this study. Research is part of their daily activities. All authors had full access to all data and take responsibility for the integrity and accuracy of the data analysis.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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