Immunology Laboratory, CHU Lyon-Sud, Pierre Bénite Cedex, France; Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France.
Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France; Department of Allergy and Clinical Immunology, CHU Lyon-Sud, Pierre Bénite Cedex, France.
J Allergy Clin Immunol Pract. 2013 May-Jun;1(3):273-9.e1. doi: 10.1016/j.jaip.2013.02.007. Epub 2013 Apr 9.
We identified a case of quinolone allergic hypersensitivity associated with quaternary ammonium (QA) sensitization, the allergic determinant of neuromuscular blocking agents (NMBAs). Concomitant sensitization to several chemically different drugs is rarely reported and raises the question of a nonfortuitous association.
We evaluated a potential association between quinolone immediate allergic hypersensitivity and NMBA sensitization.
QA-specific IgE detection was prospectively performed in 26 patients who presented an immediate hypersensitivity reaction to quinolones: 17 with a confirmed allergic hypersensitivity and 9 with allergic hypersensitivity not confirmed. We also included a control population of 88 outpatients without a history of quinolone or NMBA hypersensitivity. Patients with positive QA-specific IgE benefited from a NMBA allergologic workup.
The prevalence of positive QA-specific IgE was significantly higher in patients with quinolone allergic hypersensitivity (9/17, 53%) compared with patients with allergic hypersensitivity not confirmed (1/9, 11%) than in controls (3/88, 3.4%). In the quinolone allergic population, ofloxacin elicited inhibition of the 4 positive QA-specific IgE sera tested, in a dose-response manner. Among the 9 patients with positive QA-specific IgE, the QA sensitization (positivity of specific IgE) was confirmed by positive skin tests and/or basophil activation tests to at least 1 NMBA in 5 of the 7 tested patients.
We report here the first documentation of a high prevalence of QA sensitization in patients with quinolone allergic hypersensitivity. These results suggest a new way for NMBA sensitization. It thus seems appropriate to investigate NMBA sensitization when quinolone allergic hypersensitivity is diagnosed.
我们发现了一例与季铵（QA）致敏相关的喹诺酮过敏超敏反应，这是神经肌肉阻滞剂（NMBA）的过敏决定因素。同时对几种化学上不同的药物致敏很少见，这引发了一个非偶然关联的问题。
我们评估了喹诺酮即刻过敏超敏反应与 NMBA 致敏之间的潜在关联。
我们前瞻性地检测了 26 名对喹诺酮类药物发生即刻过敏反应的患者的 QA 特异性 IgE：17 例有明确的过敏超敏反应，9 例过敏超敏反应未经证实。我们还纳入了 88 名无喹诺酮类或 NMBA 过敏史的门诊对照人群。对 QA 特异性 IgE 阳性的患者进行 NMBA 过敏检测。
与未确诊的过敏超敏反应患者（1/9，11%）相比，喹诺酮过敏患者（9/17，53%）的 QA 特异性 IgE 阳性率显著更高。在喹诺酮过敏人群中，氧氟沙星以剂量反应方式抑制了 4 份阳性 QA 特异性 IgE 血清。在 9 份 QA 特异性 IgE 阳性的患者中，在 7 份测试的患者中，有 5 份通过阳性皮肤试验和/或嗜碱性粒细胞活化试验证实了 QA 致敏（特异性 IgE 阳性）至少对 1 种 NMBA。
我们首次报道了喹诺酮过敏患者中 QA 致敏的高患病率。这些结果提示了 NMBA 致敏的一种新方式。因此，在诊断喹诺酮过敏超敏反应时，似乎有必要调查 NMBA 致敏情况。
