Cross-reactivity between voriconazole, fluconazole and itraconazole

Abstract

This is the first report of a lack of cross-reactivity between itraconazole and voriconazole.

Generalized Fixed Drug Eruption Induced by Fluconazole Without Cross-Reactivity to Itraconazole: Lymphocyte Transformation Test Confirms the Diagnosis

“…In a drug allergy work-up, one of the main issues is to detect or exclude cross-reactivity between similar chemical molecules. Because the hypersensitivity reactions due to triazole drugs are not so common, the rate of cross-reactivity between these drugs can be conflicting among different studies [ 9 , 10 ]. Triazoles are composed of two carbon atoms, three nitrogen atoms as well as different side chains, and the molecular formulae of fluconazole and itraconazole are C 13 H 12 F 2 N 6 O and C 35 H 38 Cl 2 N 8 O 4 , respectively [ 11 , 12 ].…”

Graded isavuconazole introduction in a patient with voriconazole allergy

“…She briefly received liposomal amphotericin B, then began a graded drug challenge with isavuconazole. No recommended desensitization regimens had yet been reported for this drug, so a 5‐day protocol was designed (Table ) based on a voriconazole desensitization first reported by Pinto and Chan and utilized successfully by others …”

“…Cross‐allergenicity within the azole class remains poorly understood, with available information based mostly on case reports (see Table ). Some patients have tolerated a switch to other triazoles, while others have had recurrent allergic reactions with introduction of a new azole . The most commonly reported substitutions after azole allergy have been fluconazole for itraconazole and vice versa, about which we identified seven such reports .…”

“…Some patients have tolerated a switch to other triazoles, while others have had recurrent allergic reactions with introduction of a new azole . The most commonly reported substitutions after azole allergy have been fluconazole for itraconazole and vice versa, about which we identified seven such reports . Three of the seven patients demonstrated evidence of cross‐allergenicity, with only one of the three able to continue treatment with use of concurrent antihistamines .…”

“…The most commonly reported substitutions after azole allergy have been fluconazole for itraconazole and vice versa, about which we identified seven such reports . Three of the seven patients demonstrated evidence of cross‐allergenicity, with only one of the three able to continue treatment with use of concurrent antihistamines . Rather than a change of azoles, others have attempted reintroduction of the same triazole via graded challenge following an allergic reaction .…”