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Hypersensitivity reactions to fluoroquinolones

Roland Solensky, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


This topic will review hypersensitivity (allergic) reactions to fluoroquinolones. A general discussion of fluoroquinolones, including adverse effects other than hypersensitivity reactions, is found separately. (See "Fluoroquinolones".)


Hypersensitivity reactions, or allergic reactions, are immunologic reactions to a drug. There are several types of hypersensitivity reactions, which are broadly divided into immediate and delayed reactions, based upon the time between administration and the appearance of signs or symptoms [1]. Immediate reactions begin within one hour of the first administered dose, and delayed reactions begin later than one hour (and sometimes days) after the first dose. The intent of this classification system is to distinguish immediate reactions from other types, since immediate reactions are more likely to progress to potentially life-threatening anaphylaxis if the patient is re-exposed to the causative drug. Unfortunately, patients often do not recall the chronology of drug reactions, and thus, it is often not possible to classify reactions based on timing alone. (See "An approach to the patient with drug allergy".)

Most common — The two most common types of hypersensitivity reactions to fluoroquinolones are:

Delayed-onset maculopapular cutaneous eruptions


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Literature review current through: Nov 2017. | This topic last updated: Aug 25, 2017.
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  1. Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 2004; 113:832.
  2. Johannes CB, Ziyadeh N, Seeger JD, et al. Incidence of allergic reactions associated with antibacterial use in a large, managed care organisation. Drug Saf 2007; 30:705.
  3. Naldi L, Conforti A, Venegoni M, et al. Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions. Br J Clin Pharmacol 1999; 48:839.
  4. Scherer K, Bircher AJ. Hypersensitivity reactions to fluoroquinolones. Curr Allergy Asthma Rep 2005; 5:15.
  5. Seitz CS, Bröcker EB, Trautmann A. Diagnostic testing in suspected fluoroquinolone hypersensitivity. Clin Exp Allergy 2009; 39:1738.
  6. Slama TG. Serum sickness-like illness associated with ciprofloxacin. Antimicrob Agents Chemother 1990; 34:904.
  7. Maunz G, Conzett T, Zimmerli W. Cutaneous vasculitis associated with fluoroquinolones. Infection 2009; 37:466.
  8. Rodríguez-Morales A, Llamazares AA, Benito RP, Cócera CM. Fixed drug eruption from quinolones with a positive lesional patch test to ciprofloxacin. Contact Dermatitis 2001; 44:255.
  9. Jongen-Lavrencic M, Schneeberger PM, van der Hoeven JG. Ciprofloxacin-induced toxic epidermal necrolysis in a patient with systemic lupus erythematosus. Infection 2003; 31:428.
  10. Ball P, Mandell L, Niki Y, Tillotson G. Comparative tolerability of the newer fluoroquinolone antibacterials. Drug Saf 1999; 21:407.
  11. Ball P, Mandell L, Patou G, et al. A new respiratory fluoroquinolone, oral gemifloxacin: a safety profile in context. Int J Antimicrob Agents 2004; 23:421.
  12. Ball P, Stahlmann R, Kubin R, et al. Safety profile of oral and intravenous moxifloxacin: cumulative data from clinical trials and postmarketing studies. Clin Ther 2004; 26:940.
  13. Schmid DA, Depta JP, Pichler WJ. T cell-mediated hypersensitivity to quinolones: mechanisms and cross-reactivity. Clin Exp Allergy 2006; 36:59.
  14. Zhang L, Wang R, Falagas ME, et al. Gemifloxacin for the treatment of community-acquired pneumonia and acute exacerbation of chronic bronchitis: a meta-analysis of randomized controlled trials. Chin Med J (Engl) 2012; 125:687.
  15. Results were presented to the US Food and Drug Administration (FDA) in 2003. See slide 6. www.fda.gov/ohrms/dockets/ac/03/slides/3931S1_01_FDA-Albrecht.ppt#273 (Accessed on July 10, 2012).
  16. Shear NH, Knowles SR, Shapiro L. Cutaneous reactions to drugs. In: Fitzpatrick's Dermatology in General Medicine, 7th ed, Wolff K, Goldsmith LA, Katz SI, et al (Eds), McGraw Hill, New York 2008. p.355.
  17. Blanca-López N, Ariza A, Doña I, et al. Hypersensitivity reactions to fluoroquinolones: analysis of the factors involved. Clin Exp Allergy 2013; 43:560.
  18. Peters B, Pinching AJ. Fatal anaphylaxis associated with ciprofloxacin in a patient with AIDS related complex. BMJ 1989; 298:605.
  19. Kurata M, Kasuga Y, Nanba E, et al. Flush induced by fluoroquinolones in canine skin. Inflamm Res 1995; 44:461.
  20. Ishiwata Y, Yasuhara M. Gatifloxacin-induced histamine release and hyperglycemia in rats. Eur J Pharmacol 2010; 645:192.
  21. Manfredi M, Severino M, Testi S, et al. Detection of specific IgE to quinolones. J Allergy Clin Immunol 2004; 113:155.
  22. Messaad D, Sahla H, Benahmed S, et al. Drug provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann Intern Med 2004; 140:1001.
  23. Venturini Díaz M, Lobera Labairu T, del Pozo Gil MD, et al. In vivo diagnostic tests in adverse reactions to quinolones. J Investig Allergol Clin Immunol 2007; 17:393.
  24. Aranda A, Mayorga C, Ariza A, et al. In vitro evaluation of IgE-mediated hypersensitivity reactions to quinolones. Allergy 2011; 66:247.
  25. Chang B, Knowles SR, Weber E. Immediate hypersensitivity to moxifloxacin with tolerance to ciprofloxacin: report of three cases and review of the literature. Ann Pharmacother 2010; 44:740.
  26. González I, Lobera T, Blasco A, del Pozo MD. Immediate hypersensitivity to quinolones: moxifloxacin cross-reactivity. J Investig Allergol Clin Immunol 2005; 15:146.
  27. Fukushima K, Nakatsubo M, Noda M, et al. Anaphylaxis due to intravenous levofloxacin with tolerance to garenoxacin. Intern Med 2012; 51:1769.
  28. Dewachter P, Mouton-Faivre C. Anaphylaxis to levofloxacin. Allergol Immunopathol (Madr) 2013; 41:418.
  29. Davis H, McGoodwin E, Reed TG. Anaphylactoid reactions reported after treatment with ciprofloxacin. Ann Intern Med 1989; 111:1041.
  30. Sachs B, Riegel S, Seebeck J, et al. 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.
  31. Anovadiya AP, Barvaliya MJ, Patel TK, Tripathi CB. Cross sensitivity between ciprofloxacin and levofloxacin for an immediate hypersensitivity reaction. J Pharmacol Pharmacother 2011; 2:187.
  32. Dávila I, Diez ML, Quirce S, et al. Cross-reactivity between quinolones. Report of three cases. Allergy 1993; 48:388.
  33. Rönnau AC, Sachs B, von Schmiedeberg S, et al. Cutaneous adverse reaction to ciprofloxacin: demonstration of specific lymphocyte proliferation and cross-reactivity to ofloxacin in vitro. Acta Derm Venereol 1997; 77:285.
  34. Lobera T, Audícana MT, Alarcón E, et al. Allergy to quinolones: low cross-reactivity to levofloxacin. J Investig Allergol Clin Immunol 2010; 20:607.
  35. Sánchez-Morillas L, Rojas Pérez-Ezquerra P, Reaño-Martos M, et al. Systemic anaphylaxis caused by moxifloxacin. Allergol Immunopathol (Madr) 2010; 38:226.
  36. Demir S, Gelincik A, Akdeniz N, et al. Usefulness of In Vivo and In Vitro Diagnostic Tests in the Diagnosis of Hypersensitivity Reactions to Quinolones and in the Evaluation of Cross-Reactivity: A Comprehensive Study Including the Latest Quinolone Gemifloxacin. Allergy Asthma Immunol Res 2017; 9:347.
  37. Gea-Banacloche JC, Metcalfe DD. Ciprofloxacin desensitization. J Allergy Clin Immunol 1996; 97:1426.
  38. Lantner RR. Ciprofloxacin desensitization in a patient with cystic fibrosis. J Allergy Clin Immunol 1995; 96:1001.
  39. Empedrad R, Darter AL, Earl HS, Gruchalla RS. Nonirritating intradermal skin test concentrations for commonly prescribed antibiotics. J Allergy Clin Immunol 2003; 112:629.
  40. Uyttebroek AP, Sabato V, Bridts CH, et al. Moxifloxacin hypersensitivity: Uselessness of skin testing. J Allergy Clin Immunol Pract 2015; 3:443.
  41. Brož P, Harr T, Hecking C, et al. Nonirritant intradermal skin test concentrations of ciprofloxacin, clarithromycin, and rifampicin. Allergy 2012; 67:647.
  42. Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 2010; 105:259.