A pediatric case of immediate hypersensitivity to tosufloxacin involving no cross-reactivity to other topical quinolones

Abstract

キノロン系抗菌薬アレルギーの交差反応性は少しずつ知見が蓄積されているが，トスフロキサシントシル酸塩水和物（以下トスフロキサシン）への即時型アレルギー反応は報告が少なく，検査法や交差反応性が明確となっていない． 症例は6歳女児で，トスフロキサシンを内服10分後に顔面の膨疹，20分後に全身の膨疹が出現し，夜間救急室を受診した．喘鳴も出現し，SpO2が84%（室内気）のため，アナフィラキシーの診断でアドレナリンが筋注された．当院でのSkin prick test（トスフロキサシン100μg/mL）は平均膨疹径2mmと陰性で好塩基球活性化試験も陰性であった．薬物誘発試験では，内服10分後に顔全体の掻痒，口唇の血管性浮腫と眼瞼周囲の膨疹が出現したため，陽性と判定された． 他のキノロン系抗菌薬は，ナジフロキサシン軟膏，オフロキサシン眼軟膏の塗布試験，レボフロキサシン点眼液，モキシフロキサシン点眼液の塗布試験・点眼負荷試験は陰性で交差反応性が無いことが確認された．Although evidence for cross-reactivity in quinolone allergy is gradually accumulating, immediate hypersensitivity to tosufloxacin tosilate hydrate (tosufloxacin) have not been reported, and testing methods and cross-reactivity have not been clarified. A 6-year-old girl received tosufloxacin. She developed facial wheals 10 minutes after ingesting the drug, and generalized urticaria after 20 minutes, and she was taken to the emergency department. She was diagnosed with anaphylaxis based on stridor and 84% SpO2 and was treated with adrenaline intramuscularly. A skin prick test with 100 μg/mL of tosufloxacin was negative with an average wheal diameter of 2 mm. She performed a drug provocation test for tosfloxacin. She developed swelling and strong itching of her lips, mouth and eyelids 10 minutes after the initial dose. This case was diagnosed as immediate hypersensitivity to tosufloxacin using oral drug provocation test. We administered nadifloxacin and ofloxacin as ointment, levofloxacin and moxifloxacin as eye drops, which were also negative, indicating no cross-reactivity.journal articl