Allergy Asthma Immunol Res.  2012 Nov;4(6):367-369. 10.4168/aair.2012.4.6.367.

Immunologic Evaluation of Ofloxacin Hypersensitivity

• Nam YH
• Kim JE
• Kim SH
• Jin HJ
• Hwang EK
• Shin YS
• Ye YM
• Park HS

• KMID: 2167029
• DOI: http://doi.org/10.4168/aair.2012.4.6.367

Abstract

Quinolone hypersensitivity, most of which is immediate type, is rare but has increased in recent years. The pathogenic mechanisms underlying immediate reactions are not defined clearly. This study was aimed to observe the clinical characteristics of immediate hypersensitivity to ofloxacin and to investigate the pathogenic mechanism with detection of serum specific IgE to ofloxacin using an enzyme-linked immunoasorbent assay (ELISA). We recruited 5 patients with immediate hypersensitivity reactions to ofloxacin (group I), and as control groups, 5 subjects with ciprofloxacin hypersensitivity (group II) and 20 healthy subjects with no history of drug allergy. Serum specific-IgE to ofloxacin-human serum albumin (HSA) conjugate was detectable in four group I subjects (80%) and three group II subjects (60%). The ELISA inhibition test showed significant inhibition with both ofloxacin-HSA conjugate and free ofloxacin in a dose-dependent manner. As to ciprofloxacin, significant inhibition was noted upon addition of free ciprofloxacin in one subject, while minimal inhibition was noted in the other. We confirmed that an IgE-mediated response is a major pathogenic mechanism of ofloxacin hypersensitivity. Cross reactivity between ofloxacin and ciprofloxacin was noted with individual difference.

Keyword

Cross reactivity; enzyme-linked immunosorbent assay; IgE; immediate hypersensitivity; ofloxacin

MeSH Terms

Ciprofloxacin
Drug Hypersensitivity
Enzyme-Linked Immunosorbent Assay
Humans
Hypersensitivity
Hypersensitivity, Immediate
Immunoglobulin E
Individuality
Ofloxacin
Serum Albumin
Ciprofloxacin
Immunoglobulin E
Ofloxacin
Serum Albumin

Figure

• 

  Fig. 1 Serum specific IgE levels to ofloxacin-human serum albumin (HSA) conjugate by ELISA in patients with ofloxacin (•) and ciprofloxacin (▴) hypersensitivity and healthy controls (○). Horizontal bar indicates the cut-off value for positive specific IgE bindings.

• 

  Fig. 2 The IgE ELISA inhibition test results with serial additions of ofloxacin-HSA conjugate (•), free forms of ofloxacin (○) and ciprofloxacin (▴), and human serum albumin alone (▪). Significant inhibitions were noted upon addition of free ciprofloxacin in patient 3 of group I (A), while minimal inhibition was noted in patient 1 of group II (B).

Reference

1. Bertino J Jr, Fish D. The safety profile of the fluoroquinolones. Clin Ther. 2000. 22:798–817. discussion 797.

2. Suh YJ, Lee YM, Choi JH, Suh CH, Nahm DH, Park HS. Heterogeneity of IgE response to cefteram pivoxil was noted in 2 patients with cefteram-induced occupational asthma. J Allergy Clin Immunol. 2003. 112:209–210.

3. Kim JE, Kim SH, Jin HJ, Hwang EK, Kim JH, Ye YM, Park HS. IgE Sensitization to Cephalosporins in Health Care Workers. Allergy Asthma Immunol Res. 2012. 4:85–91.

4. Demoleas SE, Davies GF. Quinolones. Oral antibiotics of the future. J Am Podiatr Med Assoc. 1988. 78:522–525.

5. Dembry LM, Farrington JM, Andriole VT. Fluoroquinolone antibiotics: adverse effects and safety profiles. Infect Dis Clin Pract (Baltim Md). 1999. 8:421–428.

6. Aranda A, Mayorga C, Ariza A, Doña I, Rosado A, Blanca-Lopez N, Andreu I, Torres MJ. In vitro evaluation of IgE-mediated hypersensitivity reactions to quinolones. Allergy. 2011. 66:247–254.

7. Manfredi M, Severino M, Testi S, Macchia D, Ermini G, Pichler WJ, Campi P. Detection of specific IgE to quinolones. J Allergy Clin Immunol. 2004. 113:155–160.

8. Reaño M, Vives R, Rodríguez J, Daroca P, Canto G, Fernández J. Ciprofloxacin-induced vasculitis. Allergy. 1997. 52:599–600.

9. Dávila I, Diez ML, Quirce S, Fraj J, De La Hoz B, Lazaro M. Cross-reactivity between quinolones. Report of three cases. Allergy. 1993. 48:388–390.

10. Seitz CS, Bröcker EB, Trautmann A. Diagnostic testing in suspected fluoroquinolone hypersensitivity. Clin Exp Allergy. 2009. 39:1738–1745.

11. Schmid DA, Campi P, Pichler WJ. Hypersensitivity reactions to quinolones. Curr Pharm Des. 2006. 12:3313–3326.

12. González I, Lobera T, Blasco A, del Pozo MD. Immediate hypersensitivity to quinolones: moxifloxacin cross-reactivity. J Investig Allergol Clin Immunol. 2005. 15:146–149.

13. Lobera T, Audícana MT, Alarcón E, Longo N, Navarro B, Muñoz D. Allergy to quinolones: low cross-reactivity to levofloxacin. J Investig Allergol Clin Immunol. 2010. 20:607–611.