Immediate Hypersensitivity to Moxifloxacin with Tolerance to Ciprofloxacin: Report of Three Cases and Review of the Literature

Abstract

Objective

To report 3 cases of immediate hypersensitivity reactions to moxifloxacin in patients who tolerated ciprofloxacin.

Case summaries

A 71-year-old man, a 44-year-old woman, and a 70-year-old woman with a history of a moxifloxacin reaction developed an immediate hypersensitivity reaction upon oral challenge with moxifloxacin in our Drug Safety Clinic. The reaction was mainly characterized by pruritus and urticaria, although dyspnea and hypotension were noted in the first and second patient, respectively. Two of the patients had negative oral challenge tests with ciprofloxacin and all 3 patients tolerated full treatment courses of oral ciprofloxacin. In all 3 cases, use of the Naranjo probability scale indicated a highly probable adverse drug reaction.

Discussion

Moxiffoxacin, similar to other fluoroquinolones, can cause immediate hypersensitivity reactions. Previous publications have reported both cross-reactivity and a lack of cross-reactivity among various fluoroquinolones. The 3 patients discussed demonstrated a lack of cross-reactivity between moxifloxacin and ciprofloxacin since they tolerated oral challenge tests and full treatment courses of ciprofloxacin. Moxifloxacin has unique side chains at positions 7 and 8 on its bicyclic ring structure. Antigenic specificity to particular side chains at positions 7 and 8 on the bicyclic ring structure of moxifloxacin may explain this lack of cross-reactivity. Higher reporting rates of anaphylaxis to moxifloxacin compared to other fluoroquinolones may also be related to side chain specificity, although definitive evidence for this is lacking.

Conclusions

Based on our experience, patients who develop immediate hypersensitivity reactions to moxifloxacin may receive ciprofloxacin therapy in an appropriately monitored setting if they have previously tolerated full treatment courses of ciprofloxacin. Research into whether there is a specific side chain reaction unique to moxifloxacin is warranted.

Keywords

anaphylaxis ciprofloxacin cross reactions fluoroquinolones hypersensitivity immediate moxifloxacin

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References

Van Bambeke

, Michot

J.M.

, Van Eldere

, Tulkens

P.M.

. Quinolones in 2005: an update. Clin Microbiol Infect 2005; 11: 256–80. DOI 10.1111/j.1469-0691.2005.01131.x

Appelbaum

P.C.

, Hunter

P.A.

. The fluoroquinolone antibacterials: past, present and future perspectives. Int J Antimicrob Agents 2000; 16: 5–15. DOI 10.1016/S0924-8579(00)00192-8

Ball

Adverse drug reactions: implications for the development of fluoroquinolones.

J Antimicrob Chemother 2003; 51(suppl 1): 21–7. DOI 10.1093/jac/dkg209

Bertino

Jr , Fish

The safety profile of the fluoroquinolones.

Clin Ther 2000; 22: 798–817. DOI 10.1016/S0149-2918(00)80053-3

De Sarro

, De Sarro

Adverse reactions to fluoroquinolones, an overview on mechanistic aspects.

Curr Med Chem 2001; 8: 371–84.

Mehlhorn

A.J.

, Brown

D.A.

. Safety concerns with fluoroquinolones. Ann Pharmacother 2007; 41: 1859–66. DOI 10.1345/aph.1K347

Campi

, Pichler

W.J.

. Quinolone hypersensitivity. Curr Opin Allergy Clin Immunol 2003; 3: 275–81. DOI 10.1097/00130832-200308000-00007

Scherer

, Bircher

A.J.

. Hypersensitivity reactions to fluoroquinolones. Curr Allergy Asthma Rep 2005; 5: 15–21. DOI 10.1007/s11882-005-0049-1

Van Bambeke

, Tulkens

P.M.

. Safety profile of the respiratory fluoroquinolone moxifloxacin. Drug Saf 2009; 32: 359–78. DOI 10.2165/00002018-200932050-00001

10.

Alemán

A.M.

, Quirce

, Cuesta

, Novalbos

, Sastre

Anaphylactoid reaction caused by moxifloxacin.

J Investig Allergol Clin Immunol 2002; 12: 67–8.

11.

González

, Lobera

, Blasco

, del Pozo

M.D.

. Immediate hypersensitivity to quinolones: moxifloxacin cross-reactivity. J Investig Allergol Clin Immunol 2005; 15: 146–9.

12.

Sachs

, Riegel

, Seebeck

Fluoroquinolone-associated anaphylaxis in spontaneous adverse drug reaction reports in Germany: differences in reporting rates between individual fluoroquinolones and occurrence after first-ever use.

Drug Saf 2006; 29: 1087–100. DOI 10.2165/00002018-200629110-00008

13.

Naranjo

C.A.

, Busto

, Sellers

E.M.

A method for estimating the probability of adverse drug reactions.

Clin Pharmacol Ther 1981; 30: 239–45.

14.

Kothur

, Singh

, Dayal

Ciprofloxacin-induced anaphylactoid reaction.

Eur J Pediatr 2006; 165: 573–4. DOI 10.1007/s00431-006-0099-y

15.

D.Y.

, Song

J.C.

, Wang

C.C.

. Anaphylactoid reaction to ciprofloxacin. Ann Pharmacother 2003; 37: 1018–23. DOI 10.1345/aph.1C498

16.

Burke

, Burne

S.R.

. Allergy associated with ciprofloxacin. BMJ 2000; 320: 679. DOI 10.1136/bmj.320.7236.679

17.

Erdem

, Staat

M.A.

, Connelly

B.L.

, Assa'ad

Anaphylactic reaction to ciprofloxacin in a toddler: successful desensitization.

Pediatr Infect Dis J 1999; 18: 563–4. DOI 10.1097/00006454-199906000-00022

18.

Clutterbuck

D.J.

, McMillan

Anaphylactoid reaction to ciprofloxacin.

Int J STD AIDS 1997; 8: 707–8. DOI 10.1258/0956462971918931

19.

Salon

E.J.

, Newbrough

M.A.

, Albarracin

C.A.

, Hernandez

J.E.

. Anaphylactoid reaction to ciprofloxacin versus toxic shock syndrome (letter). Ann Pharmacother 1997; 31: 119–20.

20.

Vidal

, Suarez

, Martinez

, Gonzalez-Quintela

Ciprofloxacin-induced glottic angioedema (letter).

Postgrad Med J 1995; 71: 318. DOI 10.1136/pgmj.71.835.318-a

21.

Assouad

, Willcourt

R.J.

, Goodman

P.H.

. Anaphylactoid reactions to ciprofloxacin (letter). Ann Intern Med 1995; 122: 396–7.

22.

Soetikno

R.M.

, Johnson

J.L.

, Carey

J.T.

. Ciprofloxacin-induced anaphylactoid reaction in a patient with AIDS (letter). Ann Pharmacother 1993; 27: 1404.

23.

Deamer

R.L.

, Prichard

J.G.

, Loman

G.J.

. Hypersensitivity and anaphylactoid reactions to ciprofloxacin. Ann Pharmacother 1992; 26: 1081–4.

24.

Berger

T.G.

, Franklin

Anaphylactoid reaction to ciprofloxacin in a patient infected with the human immunodeficiency virus.

J Am Acad Dermatol 1992; 26: 256–7. DOI 10.1016/S0190-9622(08)80302-7

25.

Miller

M.S.

, Gaido

, Rourk

M.H.

Jr , Spock

Anaphylactoid reactions to ciprofloxacin in cystic fibrosis patients.

Pediatr Infect Dis J 1991; 10: 164–5. DOI 10.1097/00006454-199102000-00020

26.

Kennedy

C.A.

, Goetz

M.B.

, Mathisen

G.E.

. Ciprofloxacin-induced anaphylactoid reactions in patients infected with the human immunodeficiency virus (letter). West J Med 1990; 153: 563–4.

27.

Davis

, McGoodwin

, Reed

T.G.

. Anaphylactoid reactions reported after treatment with ciprofloxacin. Ann Intern Med 1989; 111: 1041–3.

28.

Wurtz

R.M.

, Abrams

, Becker

, Jacobson

M.A.

, Mass

M.M.

, Marks

S.H.

. Anaphylactoid drug reactions to ciprofloxacin and rifampicin in HIV-infected patients (letter). Lancet 1989; 1: 955–6. DOI 10.1016/S0140-6736(89)92529-4

29.

Peters

, Pinching

A.J.

. Fatal anaphylaxis associated with ciprofloxacin in a patient with AIDS related complex (letter). BMJ 1989; 298: 605. DOI 10.1136/bmj.298.6673.605-b

30.

Baciewicz

A.M.

, Georges

, Becker

, Schnall

A.M.

. Laryngeal edema related to ciprofloxacin therapy (letter). Ann Pharmacother 1992; 26: 1456.

31.

Burks

E.J.

. Norfloxacin hypersensitivity (letter). DICP 1989; 23: 90.

32.

Desai

, Desai

K.J.

, Shah

U.H.

. Ofloxacin induced hypersensitivity reaction. J Assoc Physicians India 1999; 47: 349.

33.

Smythe

M.A.

, Cappelletty

D.M.

. Anaphylactoid reaction to levofloxacin. Pharmacotherapy 2000; 20: 1520–3. DOI 10.1592/phco.20.19.1520.34868

34.

Takahama

, Tsutsumi

, Kubota

Anaphylaxis due to levofloxacin.

Int J Dermatol 2005; 44: 789–90. DOI 10.1111/j. 1365-4632.2004.02325.x

35.

González-Mancebo

, Fernández-Rivas

Immediate hypersensitivity to levofloxacin diagnosed through skin prick test (letter).

Ann Pharmacother 2004; 38: 354. DOI 10.1345/aph.1D159

36.

Stricker

B.H.

, Slagboom

, Demaeseneer

, Slootmaekers

, Thijs

, Olsson

Anaphylactic reactions to cinoxacin.

BMJ 1988; 297: 1434–5. DOI 10.1136/bmj.297.6661.1434

37.

Valdivieso

, Pola

, Losada

, Subiza

, Armentia

, Zapata

Severe anaphylactoid reaction to nalidixic acid.

Allergy 1988; 43: 71–3. DOI 10.1111/j.1398-9995.1988.tb02046.x

38.

Dávila

, Diez

M.L.

, Quirce

, Fraj

, De La Hoz

, Lazaro

Cross-reactivity between quinolones. Report of three cases.

Allergy 1993; 48: 388–90. DOI 10.1111/j.1398-9995.1993.tb02413.x.

39.

al-Hedaithy

M.A.

, Noreddin

A.M.

. Hypersensitivity anaphylactoid reaction to pefloxacin in a patient with AIDS. Ann Pharmacother 1996; 30: 612–4.

40.

Umebayashi

, Furuta

Anaphylaxis due to tosufloxacin tosilate (letter).

J Dermatol 2003; 30: 701–2.

41.

Blayac

J.P.

, Hillaire-Buys

, Pinzani

Fluoroquinolones and anaphylaxis.

Thérapie 1996; 51: 417–8.

42.

Manfredi

, Severino

, Testi

Detection of specific IgE to quinolones.

J Allergy Clin Immunol 2004; 113: 155–60. DOI 10.1016/j.jaci.2003.09.035

43.

Pichichero

M.E.

. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics 2005; 115: 1048–57. DOI 10.1542/peds.2004-1276

44.

Pichichero

M.E.

. Use of selected cephalosporins in penicillin-allergic patients: a paradigm shift. Diagn Microbiol Infect Dis 2007; 57: 13S–8S. DOI 10.1016/j.diagmicrobio.2006.12.004

45.

Kelkar

P.S.

, Li

J.T.

. Cephalosporin allergy. N Engl J Med. 2001; 345: 804–9. DOI 10.1056/NEJMra993637

46.

Andersson

M.I.

, MacGowan

A.P.

. Development of the quinolones. J Antimicrob Chemother 2003; 51(suppl 1): 1–11.DOI 10.1093/jac/dkg212

47.

Higgins

P.G.

, Fluit

A.C.

, Schmitz

F.J.

. Fluoroquinolones: structure and target sites. Curr Drug Targets 2003; 4: 181–90. DOI 10.2174/1389450033346920