title: Immediate allergic hypersensitivity to quinolones associates with neuromuscular blocking agent sensitization.
abstract: BACKGROUND
  We identified a case of quinolone allergic hypersensitivity associated with quaternary ammonium (QA) sensitization, the allergic determinant of neuromuscular blocking agents (NMBAs). Concomitant sensitization to several chemically different drugs is rarely reported and raises the question of a nonfortuitous association.
  
  
  OBJECTIVE
  We evaluated a potential association between quinolone immediate allergic hypersensitivity and NMBA sensitization.
  
  
  METHODS
  QA-specific IgE detection was prospectively performed in 26 patients who presented an immediate hypersensitivity reaction to quinolones: 17 with a confirmed allergic hypersensitivity and 9 with allergic hypersensitivity not confirmed. We also included a control population of 88 outpatients without a history of quinolone or NMBA hypersensitivity. Patients with positive QA-specific IgE benefited from a NMBA allergologic workup.
  
  
  RESULTS
  The prevalence of positive QA-specific IgE was significantly higher in patients with quinolone allergic hypersensitivity (9/17, 53%) compared with patients with allergic hypersensitivity not confirmed (1/9, 11%) than in controls (3/88, 3.4%). In the quinolone allergic population, ofloxacin elicited inhibition of the 4 positive QA-specific IgE sera tested, in a dose-response manner. Among the 9 patients with positive QA-specific IgE, the QA sensitization (positivity of specific IgE) was confirmed by positive skin tests and/or basophil activation tests to at least 1 NMBA in 5 of the 7 tested patients.
  
  
  CONCLUSIONS
  We report here the first documentation of a high prevalence of QA sensitization in patients with quinolone allergic hypersensitivity. These results suggest a new way for NMBA sensitization. It thus seems appropriate to investigate NMBA sensitization when quinolone allergic hypersensitivity is diagnosed.
authors.affiliation: Immunology Laboratory, CHU Lyon-Sud, Pierre Bénite Cedex, France; Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France. Electronic address: porouzaire@chu-clermontferrand.fr.
authors.forename: Paul
authors.initials: P
authors.lastname: Rouzaire
authors.affiliation: Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France; Department of Allergy and Clinical Immunology, CHU Lyon-Sud, Pierre Bénite Cedex, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Nosbaum
authors.affiliation: Department of Anesthesia, CHU Lyon, Pierre Bénite Cedex, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Mullet
authors.affiliation: Department of Anesthesia, CHU Lyon, Pierre Bénite Cedex, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Diot
authors.affiliation: Department of Anesthesia, CHU Lyon, Pierre Bénite Cedex, France.
authors.forename: Rolande
authors.initials: R
authors.lastname: Dubost
authors.affiliation: Immunology Laboratory, CHU Lyon-Sud, Pierre Bénite Cedex, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Bienvenu
authors.affiliation: Biomnis Laboratory, Lyon, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guilloux
authors.affiliation: Department of Anesthesia, CHU Lyon, Pierre Bénite Cedex, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Piriou
authors.affiliation: Immunology Laboratory, CHU Lyon-Sud, Pierre Bénite Cedex, France; Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bienvenu
authors.affiliation: Inserm U851, Lyon, France; Lyon1 University, IFR128, Lyon, France; Department of Allergy and Clinical Immunology, CHU Lyon-Sud, Pierre Bénite Cedex, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bérard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001491:Basophils / Q000276:immunology / Q000378:metabolism; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000276:immunology*; D007073:Immunoglobulin E / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage* / Q000494:pharmacology; D011446:Prospective Studies; D015363:Quinolones / Q000008:administration & dosage* / Q000276:immunology*
chemical_list: D009466:Neuromuscular Blocking Agents; D015363:Quinolones; D007073:Immunoglobulin E
keywords: Cross-reactivity; Drug allergy; Drug immediate hypersensitivity; Neuromuscular blocking agent; Quaternary ammonium ions; Quinolones; Sensitization