Quinolone-Induced Anaphylaxis
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Anaphylaxis (M Sanchez-Borges, Section Editor)
Quinolone-Induced Anaphylaxis Nathalia Coelho Portilho, MD Marcelo Vivolo Aun, MD, PhD Jorge Kalil, MD, PhD Pedro Giavina-Bianchi, MD, PhD* Address * Clinical Immunology and Allergy Division, School of Medicine, Universidade de São Paulo, R. Prof. Artur Ramos 178 ap.211A, Jd. América, Sao Paulo, SP, 01454904, Brazil Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Anaphylaxis Keywords Quinolones I Immediate hypersensitivity reaction I Anaphylaxis I Mast cell activation I MRGPRX2 receptor
Abstract Purpose of review Quinolones are the second most common antibiotic class that may induce IgE and non-IgE-mediated immediate hypersensitivity reactions. The prevalence of true quinolone allergy still remains unknown, but its incidence has increased in recent years, probably due to the extensive utilization of this antibiotic class and the introduction of moxifloxacin. Recent findings Quinolones may also induce nonallergic reactions through the MRGPRX2 receptor. The diagnosis of hypersensitivity reactions to quinolones is complex, since clinical history is often doubtful, skin tests can induce false-positive results, and in vitro tests are not well validated. Therefore, in many cases, the only way to confirm or rule out the diagnosis is drug provocation test, a procedure that carries some risks. Quinolones present a variable degree of cross-reactivity that is undetermined and difficult to predict, and desensitization may be required in patients with no other antibiotic options. Summary This review critically analyzed the existing data on quinolone allergy, highlighting the recent advances in its diagnosis and management. Further studies are needed to increase the knowledge in the field and to improve patients’ care.
Anaphylaxis (M Sanchez-Borges, Section Editor)
Introduction Quinolones are synthetic antibiotics that inhibit DNA gyrase in Gram-negative bacteria and topoisomerase IV in Gram-positive bacteria, inducing DNA cleavage and rapid killing of susceptible bacteria [1•]. Due to their broad-spectrum activity, excellent tissue and intracellular penetration, high bioavailability, and, generally, good oral-tolerability, the use of quinolones as firstline therapy increased in recent years [1•]. Fluoroquinolones are the most widely used members of this group of antibiotics, being ciprofloxacin, moxifloxacin, and levofloxacin the most frequent used worldwide [1•]. However, adverse effects have been
observed, including hypersensitivity reactions (HR) [2•]. As a result, the European Medicines Agency published a statement “Disabling and potentially side effects lead to suspension or restrictions of quinolone and fluoroquinolones antibiotics” in November 2018 [3]. An increase of HR to quinolones in the last decades is reported, some reactions being severe, including anaphylaxis [2•]. In this review, we emphasize the immediate hypersensitivity reactions (IHR) to quinolones, including anaphylaxis.
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