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. 2016 Jun;95(23):e3679.
doi: 10.1097/MD.0000000000003679.

Hypersensitivity to fluoroquinolones: The expression of basophil activation markers depends on the clinical entity and the culprit fluoroquinolone

Tahia D Fernández  1 , Adriana Ariza, Francisca Palomares, María I Montañez, María Salas, Angela Martín-Serrano, Rubén Fernández, Arturo Ruiz, Miguel Blanca, Cristobalina Mayorga, María J Torres
Affiliations

Hypersensitivity to fluoroquinolones: The expression of basophil activation markers depends on the clinical entity and the culprit fluoroquinolone

Tahia D Fernández et al. Medicine (Baltimore). 2016 Jun.

Erratum in

  • Erratum: Medicine, Volume 95, Issue 23: Erratum.
    [No authors listed] [No authors listed] Medicine (Baltimore). 2016 Jul 18;95(28):e0916. doi: 10.1097/01.md.0000489580.04709.16. eCollection 2016 Jul. Medicine (Baltimore). 2016. PMID: 31265603 Free PMC article.

Abstract

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.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Basophil activation test (BAT) results in fluoroquinolone (FQ)-allergic patients and controls. Comparison of expression levels for CD63 and CD203c as (A) percentage of activated cells in controls; (B) stimulation index (SI) in controls; (C) percentage of activated cells in FQ-allergic patients; (D) SI in FQ-allergic patients, represented as individual data points. Lines represent the mean of all data. Wilcoxon matched-pair tests were performed.
Figure 2
Figure 2
Comparisons of BAT results in CIP and MOX allergic patients as (A) percentage of cells expressing CD63 or upregulating CD203c and (B) stimulation index (SI) calculated with %CD63 and %CD203c. Box plots represent the median and IQR. Statistical Mann-Whitney U tests were performed. (C) Differences in activation marker up-regulation in BAT positive MOX allergic patients. Bars represent the mean and SEM of the percentage of cells expressing CD63 or CD203c in MOX allergic patients with positive BAT, discriminating between the types of reaction: Anaphylactic Shock or Anaphylaxis.
Figure 3
Figure 3
Correlation between CD63 and CD203c expression in FQ-allergic patients. Each point represents an individual patient for a given drug concentration.
See this image and copyright information in PMC

References

    1. Van Bambeke F, Tulkens PM. Safety profile of the respiratory fluoroquinolone moxifloxacin: comparison with other fluoroquinolones and other antibacterial classes. Drug Safety 2009; 32:359–378. - PubMed
    1. Ball P. Quinolone generations: natural history or natural selection? J Antimicrob Chemother 2000; 46 (suppl T1):17–24. - PubMed
    1. Dona I, Blanca-Lopez N, Torres MJ, et al. Drug hypersensitivity reactions: response patterns, drug involved, and temporal variations in a large series of patients. J Investig Allergol Clin Immunol 2012; 22:363–371. - PubMed
    1. Johannes CB, Ziyadeh N, Seeger JD, et al. Incidence of allergic reactions associated with antibacterial use in a large, managed care organisation. Drug Safety 2007; 30:705–713. - PubMed
    1. Blanca-Lopez N, Andreu I, Torres Jaen MJ. Hypersensitivity reactions to quinolones. Curr Opin Allerg Clin Immunol 2011; 11:285–291. - PubMed