Are skin tests useful in fluoroquinolone hypersensitivity diagnosis?

Perez, Eva; Callero, Ariel; Martinez-Tadeo, Juan Antonio; Hernández, G; Rodríguez-Plata, Elena; Almeida, Zulay; García-Robaina, José Carlos

doi:10.1016/j.anai.2013.08.012

Cited by 10 publications

(9 citation statements)

References 5 publications

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“…Although some studies reported that skin testing was useful,610111213 controversial results have also been published 91418. Our study revealed that the sensitivity of STs with quinolones was very low as confirmed with SBPCDPTs.…”

Section: Discussionsupporting

confidence: 49%

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Demir

Gelincik

Akdeniz

et al. 2017

Allergy Asthma Immunol Res

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PurposeReports evaluating diagnosis and cross reactivity of quinolone hypersensitivity have revealed contradictory results. Furthermore, there are no reports investigating the cross-reactivity between gemifloxacin (GFX) and the others. We aimed to detect the usefulness of diagnostic tests of hypersensitivity reactions to quinolones and to evaluate the cross reactivity between different quinolones including the latest quinolone GFX.MethodsWe studied 54 patients (mean age 42.31±10.39 years; 47 female) with 57 hypersensitivity reactions due to different quinolones and 10 nonatopic quinolone tolerable control subjects. A detailed clinical history, skin test (ST), and single-blind placebo-controlled drug provocation test (SBPCDPT), as well as basophil activation test (BAT) and lymphocyte transformation test (LTT) were performed with the culprit and alternative quinolones including ciprofloxacin (CFX), moxifloxacin (MFX), levofloxacin (LFX), ofloxacin (OFX), and GFX.ResultsThe majority (75.9%) of the patients reported immediate type reactions to various quinolones. The most common culprit drug was CFX (52.6%) and the most common reaction type was urticaria (26.3%). A quarter of the patients (24.1%) reacted to SBPCDPTs, although their STs were negative; while false ST positivity was 3.5% and ST/SBPCDPTs concordance was only 1.8%. Both BAT and LTT were not found useful in quinolone hypersensitivity. Cross-reactivity was primarily observed between LFX and OFX (50.0%), whereas it was the least between MFX and the others, and in GFX hypersensitive patients the degree of cross-reactivity to the other quinolones was 16.7%.ConclusionsThese results suggest that STs, BAT, and LTT are not supportive in the diagnosis of a hypersensitivity reaction to quinolone as well as in the prediction of cross-reactivity. Drug provocation tests (DPTs) are necessary to identify both culprit and alternative quinolones.

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Section: Discussionsupporting

confidence: 49%

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Demir

Gelincik

Akdeniz

et al. 2017

Allergy Asthma Immunol Res

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“…Fluoroquinolones are known to have skin-irritating properties [ 45 ]. Recent studies have reported contrasting but interesting results.…”

Section: Methodsmentioning

confidence: 99%

“…Fluoroquinolones, in addition to beta-lactams, cause one of the most common antibiotic allergies, and this hypersensitivity has become increasingly common with increased prescription rates of the drug [ 44 ]. BAT has gained considerable interest for testing fluoroquinolone hypersensitivities because the diagnostic utility of skin tests is very limited due to its skin-irritation properties in intradermal tests (88% false positives) [ 45 ]. To date, seven studies [ 46 - 52 ] have investigated the diagnostic utility of BAT ( Table 4 ).…”

Section: Clinical Applicationsmentioning

confidence: 99%

Recent applications of basophil activation tests in the diagnosis of drug hypersensitivity

Song

Chang

2013

Asia Pacific Allergy

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Immediate-type drug hypersensitivity is an increasingly significant clinical issue; however, the diagnosis is frequently hindered due to lack of safe and precise diagnostic tests. Flow cytometry-assisted basophil activation test is a safe in vitro diagnostic tool for assessing basophil activation upon allergen stimulation. In this review, we have summarized current literature on the diagnostic utilities, new indications, and methodological aspects of the basophil activation test for the diagnosis of drug hypersensitivity.

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“…In cases where patient history is not reliable, other diagnostic tests may be necessary to assess quinolone allergy. In recent years, multiple studies have been conducted to evaluate various diagnostic tests including skin tests, drug provocation tests (DPT), and in-vitro laboratory tests [24,27,28,29,30,31,32,33,34,35,36,37,38]. However, skin tests and in vitro tests have displayed low sensitivity and specificity, limiting their diagnostic utility [24,30,32,33,35,36,38].…”

Section: Evaluation and Diagnosismentioning

confidence: 99%

“…DPTs are considered the “gold standard” for establishing or excluding diagnosis of quinolone allergy, but they are time consuming and involve risks such as provocation of severe reactions [6]. Therefore, it is recommended that the procedure be performed after weighing the risks vs. the benefits and by trained personnel in a clinical setting where treatment for possible severe reactions is readily available [6,36]. Different doses and numbers of test doses have been utilized for a DPT, as depicted in Table 1 [5,6,8,15,25,32,33,34,36].…”

Section: Evaluation and Diagnosismentioning

confidence: 99%

Quinolone Allergy

et al. 2019

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Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. Although the incidence of quinolone allergy is still lower than beta-lactams, it has been increasingly reported in recent decades, most likely from its expanded use and the introduction of moxifloxacin. Thorough patient history remains essential in the evaluation of quinolone allergy. Many diagnostic tools have been investigated, but skin tests can yield false-positive results and in vitro tests have not been validated. The drug provocation test is considered the test of choice to confirm a quinolone allergy but is not without risk. Evidence regarding cross-reactivity among the quinolones is limited and conflicting. Quinolone allergy can be manifested either as an immediate or delayed reaction, but is not uniform across the class, with moxifloxacin posing the highest risk of anaphylaxis. Quinolone should be discontinued when an allergic reaction occurs and avoided in future scenarios, but desensitization may be warranted if no alternatives are available.

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Are skin tests useful in fluoroquinolone hypersensitivity diagnosis?

Cited by 10 publications

References 5 publications

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Usefulness ofIn VivoandIn VitroDiagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin

Recent applications of basophil activation tests in the diagnosis of drug hypersensitivity

Quinolone Allergy

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