Quinine is the main alkaloid derived from cinchona bark. It is used in medicine mainly as an antimalarial drug but also as an antipyretic and analgesic easily available in many over-the-counter preparations (treatment of leg cramps).
Anaphylaxis is uncommon.
Thrombocytopenia is more frequent (1/1000 to 1/3500).
Anaphylactic shock, fever.
Eczematous eruption (photoallergic), lichenoid photosensitivity, contact dermatitis (hair lotions), fixed drug eruption, allergic vasculitis, rash.
Agranulocytosis, thrombocytopenia, hemolytic uremic syndrome, disseminated intravascular coagulation.
Intradermal skin-tests: positive 1/1000 in one case of anaphylaxis.
Patch-tests (quinine 1% pet).
Quinine dependent neutrophil antibodies IgG, IgM (immuno-fluorescence, agglutination).
Quinine dependent platelet antibodies IgG, IgM (immuno-fluorescence).
Quinine dependent erythrocyte antibodies (antiglobulin test).
Positive RAST and RAST-inhibition in one case of anaphylaxis.
Oral provocation test: positive in one case of anaphylaxis.
IgE-mediated hypersensitivity: few cases with positive cutaneous tests and specific IgE.
Cytotoxicity: thrombocytopenia, anemia, leukopenia.
Delayed cell-mediated hypersensitivity: contact dermatitis.
Cross-sensitivity between quinine and quinidine (photoallergy)
Quinine should be available one prescription only.
Warning of quinine potential harmful effects should be printed on all over the counter preparations and on bottles of tonic-water.