Introduction

Desensitization is the immunological process in which a temporary tolerance is established against the drug to which the individual is allergic. This tolerance disappears when the treatment is interrupted.¹ Desensitization, which was previously recommended only for IgE-mediated reactions, is now also recommended for non-IgE-mediated, non-immunological, and T cell-mediated late-type reactions. In desensitization, drug doses are increased every 15 min, not exceeding twofold.² There are different desensitization schemes defined for each antibiotic group. There is a desensitization scheme defined and widely used for chemotherapy agents in intravenous form.³ However, there is still such a need for drugs in oral form. Two separate desensitization schemes for ciprofloxacin were defined a long time ago. However, these schemes are multistep processes requiring a long time.^4,5 Therefore, a new scheme is needed. We wanted to present the oral desensitization scheme that we use, which is practical.

Cases

Case 1

A 38-year-old female patient diagnosed with cystic fibrosis had Pseudomonas aeruginosa in her sputum culture. Ciprofloxacin was recommended due to the bacteria’s sensitivity to the drug. However, the patient had a history of hypersensitivity to ciprofloxacin 5 years ago. The patient experienced itching, redness, wheezing, and decreased blood pressure 20 min after taking the tablet. The skin prick test (2 mg/mL) was negative, while the intradermal test (0.006 mg/mL) was positive with ciprofloxacin. The patient underwent desensitization with ciprofloxacin tablets (Scheme 1). She had no complaints after desensitization and completed her treatment (Figure 1).

Figure 1 Case 1 intradermal test (0.006 mg/mL) was positive with ciprofloxacin.

Case 2

A 49-year-old female patient diagnosed with bronchiectasis had P. aeruginosa in her sputum culture. Ciprofloxacin was recommended due to the bacteria’s sensitivity . However, the patient had a history of hypersensitivity to ciprofloxacin 2 years ago. She developed urticaria 1 h after taking the tablet. The skin prick test (2 mg/mL) was negative, whereas the intradermal test (0.0006 mg/mL) was positive with ciprofloxacin. The patient underwent desensitization with ciprofloxacin tablets (Scheme 1). She had no complaints after desensitization, and completed her treatment (Figure 2).

Figure 2 Case 2 intradermal test (0.0006 mg/mL) was positive with ciprofloxacin.

Discussion

The most common hypersensitivity reaction to ciprofloxacin is anaphylaxis. False-positive skin tests may occur. In the current situation, it is recommended to avoid the drug responsible for hypersensitivity. If the drug is necessary, desensitization is considered.⁶ Oral administration reduces hospital costs and allows the patient to use the drug at home. There are very few desensitization schemes described in the literature, and they take around 4–6 h.^4,5 Therefore, a new and rapid desensitization scheme is needed. Therefore, this easy-to-apply and practical scheme was tested on two separate patients, and in both cases, desensitization and treatment were completed without any problems.