Immediate Hypersensitivity to Fluoroquinolones: 
A Cohort Assessing Cross-Reactivity

• Published in: Open forum infectious diseases 2022-04, Vol.9 (4), p.ofac106-ofac106
• Main Authors: Azimi, Sara F, Mainella, Vincent, Jeffres, Meghan N
• Format: Article
• Language: English
• Subjects: Invited
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofac106

Abstract Background Fluoroquinolones are the second-most prescribed antimicrobial and are frequently associated with causing hypersensitivity reactions. Existing evidence regarding cross-reactivity of fluoroquinolones is limited, offering clinicians little guidance in understanding the implications of selecting an in-class alternative among patients with histories of allergic reactions to fluoroquinolones. The aim of this study was to compare the frequency of immediate hypersensitivity reactions to ciprofloxacin, levofloxacin, and/or moxifloxacin among patients with a history of immediate hypersensitivity to a different fluoroquinolone. Methods This retrospective chart review included adult patients with a history of an immediate hypersensitivity reaction to ciprofloxacin, levofloxacin, and/or moxifloxacin and a documented prescription for a different fluoroquinolone. The primary outcome was documentation of a hypersensitivity reaction upon second fluoroquinolone exposure. Results A total of 321 cases met inclusion criteria. Of these cases, 2.5% experienced an immediate hypersensitivity reaction after second fluoroquinolone exposure to ciprofloxacin, levofloxacin, and/or moxifloxacin. Within the ciprofloxacin, levofloxacin, and moxifloxacin index allergy cohorts, the frequency of cross-reactivity was 2.5%, 2.0%, and 5.3%, respectively. Conclusions Our data suggest that patients with a history of immediate hypersensitivity reaction to ciprofloxacin, levofloxacin, and/or moxifloxacin are at low risk of experiencing a cross-reaction when exposed to a different fluoroquinolone. Avoidance of all fluoroquinolones in this patient population may not be warranted. This retrospective investigation of 321 cases of fluoroquinolone exposure in patients with history of immediate fluoroquinolone allergy yielded a 2.5% cross-reactivity frequency.