ArticleThe journal of allergy and clinical immunology. Global2026
Potential limited cross-drug reaction among fluoroquinolones: A large database analysis by International Classification of Diseases, Tenth Revision code-based approach.
Article in The journal of allergy and clinical immunology. Global, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Fluoroquinolone allergy is the third most commonly reported antibiotic allergy. Cross-drug reactions among fluoroquinolones remain a clinical concern, although existing studies are limited by small sample sizes and a lack of control groups. Objective: We aimed to assess the real-world frequency and risk of potential fluoroquinolone cross-drug reactions using a large health care database. Methods: We performed a retrospective analysis using the TriNetX database in September 2025. Patients with an allergy label to ciprofloxacin, levofloxacin, or moxifloxacin who were subsequently exposed to a different fluoroquinolone were identified. Potential cross-drug reactions following the second fluoroquinolone exposure were assessed based on the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. Odds ratios for potential cross-drug reactions were calculated. Results: The frequencies of potential cross-drug reactions following a second fluoroquinolone exposure were as follows: 2.6% (index allergy to ciprofloxacin, subsequent allergy to levofloxacin), 1.5% (ciprofloxacin → moxifloxacin), 2.7% (levofloxacin → ciprofloxacin), 1.3% (levofloxacin → moxifloxacin), 2.9% (moxifloxacin → ciprofloxacin), and 2.9% (moxifloxacin → levofloxacin). Compared with patients without an index fluoroquinolone allergy, the odds of experiencing a potential cross-drug reaction were slightly higher in some drug pairs: 1.18 (ciprofloxacin → levofloxacin; 95% confidence interval [CI] 1.06-1.31; Conclusion: Potential cross-drug reactions between ciprofloxacin, levofloxacin, and moxifloxacin were rare (∼2%) and slightly increased the odds of subsequent reaction in some drug pairs. These findings suggest class-wide avoidance may be unnecessary and support drug challenge as a safe strategy in selected patients. Interpretation of our findings should be cautious, as this is an International Classification of Diseases, Tenth Revision code-based approach without detailed mechanisms.
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