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Negative Test, Persistent Avoidance: Real-World Outcomes of Quinolone De-Labeling.

Kutay Kırdök1, Ceyda Tunakan Dalgıç1, Ragıp Fatih Kural1

  • 1Division of Immunology and Allergy, Department of Internal Medicine, Faculty of Medicine, Ege University, 35100 İzmir, Türkiye.

Journal of Clinical Medicine
|June 12, 2026
PubMed
Summary

Diagnosing quinolone hypersensitivity is challenging. While skin tests have low specificity, successful allergy de-labeling doesn't ensure patients will reuse the antibiotic due to anxiety.

Keywords:
de-labelingdrug provocation testquinolone hypersensitivityreal-world outcomesskin test

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Area of Science:

  • Allergy and Immunology
  • Pharmacology

Background:

  • Quinolones are frequently implicated in immediate hypersensitivity reactions.
  • Diagnostic evaluation and real-world patient behavior post-de-labeling are understudied.

Purpose of the Study:

  • To examine the diagnostic work-up for suspected quinolone hypersensitivity.
  • To assess patient outcomes and drug-use behavior after allergy de-labeling.

Main Methods:

  • Single-center ambispective study of 29 patients evaluated for quinolone hypersensitivity.
  • Retrospective data extraction of clinical, demographic, skin tests, and drug provocation tests (DPT).
  • Structured telephone interviews with patients post-de-labeling.

Main Results:

  • Anaphylaxis was the most common reaction; ciprofloxacin was the most frequent agent.
  • Skin tests showed high positivity (84.2%) but low positive predictive value (20.0% in DPT-tested subset).
  • Of 12 interviewed, 11 had allergy excluded; only 36.4% reused the de-labeled quinolone.

Conclusions:

  • Quinolone skin tests have limited specificity.
  • Successful de-labeling does not guarantee real-world quinolone reuse.
  • Patient anxiety and counseling are critical for managing quinolone hypersensitivity.