Doña Inmaculada, Moreno Esther, Pérez-Sánchez Natalia, Andreu Inmaculada, Hernández Fernandez de Rojas Dolores, Torres María José
Allergy Unit, Pabellón 6, primera planta, IBIMA Regional University Hospital of Malaga-UMA (Pavillion C, Hospital Civil), Plaza del Hospital Civil, 29009, Malaga, Spain.
Allergy Service, University Hospital of Salamanca, Salamanca, Spain.
Curr Allergy Asthma Rep. 2017 Aug;17(8):56. doi: 10.1007/s11882-017-0725-y.
Quinolones are a group of synthetic antibiotics widely use as first-line treatment for many infections. There has been an increase in the incidence of hypersensitivity reactions to quinolones in recent years, likely due to increased prescription. The purpose of this review is to summarize the clinical pictures, the methods used for diagnosing and the management of allergic reactions to quinolones.
Allergic reactions to quinolones can be immediate or delayed, being anaphylaxis and maculopapular exanthema respectively the most frequent clinical entities. A precise diagnosis is particularly difficult since clinical history is often unreliable, skin tests can induce false-positive results, and commercial in vitro test are not well validated. Therefore, drug provocation testing is considered the gold standard to establish diagnosis, which is not a risk-free procedure. Cross-reactivity between quinolones is difficult to predict due to the small number of patients included in the few published studies. Moreover, hypersensitivity to quinolones has also been associated with beta-lactam and neuromuscular blocking agent allergies, although further studies are needed to understand the underlying mechanisms. Avoidance of the culprit quinolone is indicated in patients with a diagnosis of hypersensitivity to these drugs. When quinolone treatment is the only therapeutic option available, desensitization is necessary. This review summarizes the complex diagnostic approach and management of allergic reactions to quinolones.
喹诺酮类是一类合成抗生素，广泛用作多种感染的一线治疗药物。近年来，喹诺酮类药物过敏反应的发生率有所增加，这可能是由于处方量增加所致。本综述的目的是总结喹诺酮类药物过敏反应的临床表现、诊断方法和治疗措施。
喹诺酮类药物过敏反应可分为速发型或迟发型，最常见的临床表现分别为过敏反应和斑丘疹。由于临床病史往往不可靠、皮肤试验可能产生假阳性结果且商业化的体外试验验证不足，因此准确诊断尤为困难。因此，药物激发试验被认为是确诊的金标准，但这并非毫无风险的操作。由于已发表的研究纳入的患者数量较少，喹诺酮类药物之间的交叉反应难以预测。此外，喹诺酮类药物过敏还与β-内酰胺类和神经肌肉阻滞剂过敏有关，不过需要进一步研究以了解其潜在机制。诊断为喹诺酮类药物过敏的患者应避免使用致敏的喹诺酮类药物。当喹诺酮类药物治疗是唯一可用的治疗选择时，则需要进行脱敏治疗。本综述总结了喹诺酮类药物过敏反应复杂的诊断方法和治疗措施。
