Fernández Tahia D, Ariza Adriana, Palomares Francisca, Montañez María I, Salas María, Martín-Serrano Angela, Fernández Rubén, Ruiz Arturo, Blanca Miguel, Mayorga Cristobalina, Torres María J
Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain. Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.
Medicine (Baltimore). 2016 Jun;95(23):e3679. doi: 10.1097/MD.0000000000003679.
Although fluoroquinolones (FQs) are generally well-tolerated antibiotics, increasing numbers of hypersensitivity reactions have been reported. These can be evaluated in vitro by basophil activation tests (BATs); however, sensitivity is not optimal. Many factors could influence sensitivity such as basophil activation markers. The objective of this study was to evaluate the influence of 2 different activations markers, CD63 and CD203c, on the sensitivity of BAT to FQ. We studied 17 patients with immediate allergic reactions to FQ. BAT was performed with moxifloxacin and ciprofloxacin using CD193 (CCR3) for basophil selection and CD203c or CD63 as activation markers. Stimulation with ciprofloxacin induced a significantly higher expression of CD63 in ciprofloxacin-allergic patients compared to moxifloxacin-allergic patients (P = 0.002). In patients allergic to moxifloxacin with anaphylactic shock, we have observed an increase in the percentage of cells that upregulate CD203c, whereas patients with anaphylaxis preferentially upregulate CD63. The best sensitivity-specificity was obtained using a cutoff of 3 and the culprit FQ, using CD203c for moxifloxacin-allergic patients (sensitivity = 36.4%; specificity = 94.4%), and CD63 for ciprofloxacin-allergic patients (sensitivity = 83.3%; specificity = 88.9%). A negative correlation was found between the upregulation of CD63 and CD203c and the time interval between the reaction occurrence and the performance of the test (Spearman r = -0.446; P < 0.001 for CD63 and Spearman r = -0.386; P < 0.001 for CD203c). The performance of BAT for FQ allergy must be optimized for each drug, taking into account possible differences in the stimulation mechanism that leads to the upregulation of different activation markers.
尽管氟喹诺酮类（FQ）抗生素通常耐受性良好，但报告的过敏反应数量却在增加。这些反应可通过嗜碱性粒细胞活化试验（BAT）进行体外评估；然而，其敏感性并非最佳。许多因素可能会影响敏感性，如嗜碱性粒细胞活化标志物。本研究的目的是评估两种不同的活化标志物CD63和CD203c对BAT检测FQ敏感性的影响。我们研究了17例对FQ有速发型过敏反应的患者。使用CD193（CCR3）进行嗜碱性粒细胞分选，以莫西沙星和环丙沙星进行BAT，并使用CD203c或CD63作为活化标志物。与对莫西沙星过敏的患者相比，环丙沙星过敏患者中环丙沙星刺激诱导的CD63表达显著更高（P = 0.002）。在发生过敏性休克的对莫西沙星过敏的患者中，我们观察到上调CD203c的细胞百分比增加，而过敏反应患者则优先上调CD63。使用截断值3和可疑FQ时，对莫西沙星过敏的患者使用CD203c获得了最佳的敏感性-特异性（敏感性 = 36.4%；特异性 = 94.4%），对环丙沙星过敏的患者使用CD63（敏感性 = 83.3%；特异性 = 88.9%）。发现CD63和CD203c的上调与反应发生和检测进行之间的时间间隔呈负相关（CD63的Spearman r = -0.446；P < 0.001，CD203c的Spearman r = -0.386；P < 0.001）。对于FQ过敏的BAT检测性能，必须针对每种药物进行优化，同时考虑导致不同活化标志物上调的刺激机制可能存在的差异。
