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

Doña I1, Blanca-López N2, Boteanu C3, Cueva-Oliver B4, Fernández-Sánchez FJ5, Gajate P6, García-Avilés MC7, García-Núñez I8,9, Lobera T10, Moreno E11, Rojas P12, Rosado A13

1Allergy Unit, Hospital Regional Universitario de Málaga. Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Regional Universitario de Málaga. Málaga, Spain.
2Allergy Service, Infanta Leonor University Hospital. Madrid, Spain.
3 Allergy Service, Hospital Central De la Cruz Roja San José y Santa Adela. Madrid, Spain.
4Allergy Section, Hospital General Universitario de Alicante. ISABIAL
5Allergy Section, Hospital General Universitario de Alicante. UMH-ISABIAL. Alicante, Spain.
6Allergy Service, Hospital Rey Juan Carlos. Móstoles (Madrid), Spain.
7Allergy Unit. Hospital Universitario Moncloa. Madrid. Spain.
8Allergy and pneumology department. Hospital Quirón Salud Campo de Gibraltar. Cádiz, Spain.
9Allergy department, Hospital Quirónsalud Córdoba. Córdoba, Spain.
10Department of Allergy, San Pedro University Hospital. Logroño (La Rioja), Spain.
11Allergy Service, University Hospital of Salamanca. Institute for Biomedical Research of Salamanca (IBSAL). Salamanca, Spain.
12Allergy Service, Hospital General Universitario Gregorio Marañón. Madrid, Spain.
13Allergy Unit, Hospital Universitario Fundación Alcorcón. Madrid, Spain.

J Investig Allergol Clin Immunol 2021; Vol. 31(4)
doi: 10.18176/jiaci.0669

Over recent years, the consumption of quinolones as first-line treatment has increased, leading to a growth in incidence of hypersensitivity reactions (HSRs) to this group of antibiotics. Both diagnosis and management of HSRs to quinolones are complex and controversial. These practical guidelines aim to provide recommendations for an effective clinical practice. With this purpose, an expert panel reviewed the literature regarding HSRs to quinolones and analyzed controversies in this area.
Most HSRs to these drugs are immediate and severe, being the risk for HSR higher in subjects who reported allergy to betalactams, moxifloxacin-induced anaphylaxis and immediate reactions (IRs) compared with patients who reported reactions to quinolones inducing other symptoms. Regarding diagnosis of HSRs to quinolones, the usefulness of skin tests is controversial, with sensitivity and specificity varying among studies. Most in vitro tests are produced in-house, with no validated commercial ones and basophil activation test being useful for diagnosing IRs although with diverse results regarding sensitivity. Drug provocation test is nowadays the gold standard for confirming or excluding the diagnosis as well as to find safe alternatives, although contraindicated for severe reactions. Cross-reactivity among quinolones is controversial among different studies, with the lowest cross-reactivity for levofloxacin. Desensitization may be considered in allergy to quinolones when no other alternative exist.

Key words: Drug allergy, Quinolones, Anaphylaxis, Skin test, Drug provocation test, Basophil activation test