Seitz C S, Bröcker E B, Trautmann A
Department of Dermatology, Venereology and Allergology, University of Würzburg, Germany.
Clin Exp Allergy. 2009 Nov;39(11):1738-45. doi: 10.1111/j.1365-2222.2009.03338.x. Epub 2009 Sep 3.
Because of their broad antibacterial activity in the gram-negative and gram-positive spectrum, high oral bioavailability, and good tissue penetration, fluoroquinolone antibiotics are widely used. Besides direct drug-related side-effects, fluoroquinolones may cause hypersensitivity reactions.
The aim of this retrospective analysis was to present the results of diagnostic testing in cases of clinically suspected fluoroquinolone-induced immediate or delayed hypersensitivity.
We studied 101 patients with a history of immediate or delayed hypersensitivity symptoms in temporal relation to treatment with a fluoroquinolone antibiotic using standardized skin testing, followed by oral challenges. Patients with anaphylaxis symptoms were further evaluated with in vitro tests.
Fluoroquinolone hypersensitivity was excluded in 71 patients by tolerated oral challenge tests. During positive challenge tests, six patients (three out of these had positive and three had negative skin prick tests) developed anaphylaxis symptoms but the presumed IgE-mediated mechanism could not be confirmed by in vitro tests. Patch testing was constantly negative; however, in two patients a rash was induced by the challenge tests.
History alone leads clearly to a considerable over-estimation of fluoroquinolone hypersensitivity. Moreover, skin or in vitro tests do not seem to be very useful in identifying hypersensitive patients. Challenge tests appear to be necessary for definitely confirming or ruling out fluoroquinolone hypersensitivity.
氟喹诺酮类抗生素因其对革兰氏阴性菌和革兰氏阳性菌具有广泛的抗菌活性、高口服生物利用度以及良好的组织穿透力而被广泛使用。除了直接的药物相关副作用外，氟喹诺酮类药物可能会引起过敏反应。
这项回顾性分析的目的是呈现临床疑似氟喹诺酮类药物引起的即刻或延迟过敏反应病例的诊断测试结果。
我们研究了101例有即刻或延迟过敏症状病史且与氟喹诺酮类抗生素治疗存在时间关联的患者，采用标准化皮肤试验，随后进行口服激发试验。有过敏症状的患者进一步通过体外试验进行评估。
71例患者通过耐受的口服激发试验排除了氟喹诺酮类药物过敏。在阳性激发试验中，6例患者（其中3例皮肤点刺试验阳性，3例阴性）出现了过敏症状，但体外试验无法证实推测的IgE介导机制。斑贴试验始终为阴性；然而，在2例患者中激发试验诱发了皮疹。
仅凭病史显然会导致对氟喹诺酮类药物过敏的严重高估。此外，皮肤试验或体外试验似乎对识别过敏患者不太有用。激发试验对于明确证实或排除氟喹诺酮类药物过敏似乎是必要的。
