Resistance to Ciprofloxacin following misuse in the aftermath of Dombivali fever, in ‘80s may be remembered by all. Of late allergic reactions to quinolones have been noticed with increasing frequency. The reactions are not immediate type hypersensitivity but cross reactivity.                              Team@CMHF

Immediate-type hypersensitivity reactions to quinolones are rare. Some reports describe the presence of cross-reactivity among different members of the group, although no predictive pattern has been established.

A joint study was designed between 2 allergy departments to assess cross-reactivity between levofloxacin and other quinolones. Allergy was confirmed by skin tests and controlled oral challenge tests with different quinolones. The basophil activation test (BAT) was applied in 6 patients

RESULTS-The skin tests were positive in 5 patients with levofloxacin (2), moxifloxacin (2), and ofloxacin (2). BAT was negative in all patients (6/6). Most of the ciprofloxacin-reactive patients (4/5) tolerated levofloxacin. Similarly, 3 of 4 levofloxacin-reactive patients tolerated ciprofloxacin. Patients who reacted to moxifloxacin and norfloxacin tolerated ciprofloxacin and levofloxacin.

CONCLUSIONS- Results suggest that skin testing and BAT do not help to identify the culprit drug or predict cross-reactivity. Oral challenge testing is the only way to confirm tolerance to a quinolone before prescribing it as a safe alternative.

Levofloxacin could be a safer alternative in cases of reaction to first-, second-, or fourth-generation quinolones.

Ref: http://www.docguide.com/allergy-quinolones-low-cross-reactivity-levofloxacin?hash=80445d1a&eid=18446&alrhash=2efbb8-880279c42369cc2f8adcb48a6daaf3d2