Publication:
Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Quinolones.

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Date

2021-01-13

Authors

Doña, I
Blanca-Lopez, N
Boteanu, C
Cueva-Oliver, B
Fernandez-Sanchez, F J
Gajate, P
Garcia-Aviles, M C
Garcia-Nuñez, I
Lobera, T
Moreno, E

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Esmon Publicidad
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Abstract

The consumption of quinolones as first-line treatment has increased in recent years, leading to an increase in the incidence of hypersensitivity reactions (HSRs) to this antibiotic group. Both diagnosis and management of HSRs to quinolones are complex and controversial. These practical guidelines aim to provide recommendations for effective clinical practice. The recommendations were drafted by an expert panel that reviewed the literature regarding HSRs to quinolones and analyzed controversies in this area. Most HSRs to quinolones are immediate and severe. The risk for HSRs is higher in patients who report allergy to ß-lactams, moxifloxacininduced anaphylaxis, and immediate reactions than in patients who report reactions to quinolones inducing other symptoms. The usefulness of skin tests in diagnosing HSRs to quinolones is controversial, with sensitivity and specificity varying between studies. Most in vitro tests are produced in-house, with no validated commercial options. The basophil activation test has proven useful for diagnosing immediate reactions, albeit with diverse results regarding sensitivity. Drug provocation testing is currently the gold standard for confirming or excluding the diagnosis and for finding safe alternatives, although it is contraindicated in patients with severe reactions. Cross-reactivity between quinolones has proven controversial in several studies, with the lowest cross-reactivity reported for levofloxacin. Desensitization may be considered in allergy to quinolones when no other alternatives are available.

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MeSH Terms

Allergens
Anti-Allergic Agents
Basophil Degranulation Test
Cross Reactions
Desensitization, Immunologic
Drug Hypersensitivity
Drug-Related Side Effects and Adverse Reactions
Humans
Practice Guidelines as Topic
Quinolones
Skin Tests

DeCS Terms

Quinolonas
Hipersensibilidad
Informe de Investigación
Anafilaxia
Pruebas Cutáneas
Prueba de Desgranulación de los Basófilos

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Keywords

Anaphylaxis, Basophil activation test, Drug allergy, Drug provocation test, Quinolones, Skin test

Citation

Doña I, Blanca-López N, Boteanu C, Cueva-Oliver B, Fernández-Sánchez FJ, Gajate P, et al. Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Quinolones. J Investig Allergol Clin Immunol. 2021 Jul 26;31(4):292-307