Successful Desensitization to Voriconazole

Cross-reactivity between voriconazole, fluconazole and itraconazole

“…In 2009, Pinto and Chan described a successful supervised graded challenge with oral voriconazole in a patient who developed a systemic allergic reaction to fluconazole, thus implying that no cross‐reactivity exists between fluconazole and voriconazole . Since that time, however, there have been no other additional accounts to confirm lack of cross‐reactivity between fluconazole and voriconazole, nor any reports of success or failure with a voriconazole challenge with an azole allergy other than fluconazole . We report successful use of Pinto and Chan's voriconazole challenge in a patient who had allergic reactions to both fluconazole and itraconazole.…”

“…5 Since that time, however, there have been no other additional accounts to confirm lack of cross-reactivity between fluconazole and voriconazole, nor any reports of success or failure with a voriconazole challenge with an azole allergy other than fluconazole. 6 We report successful use of Pinto and Chan's voriconazole challenge in a patient who had allergic reactions to both fluconazole and itraconazole. To our knowledge, this is also the first case to show a lack of cross-reactivity between voriconazole and itraconazole.…”

Antifungal hypersensitivity reactions and cross-reactivity patterns

“…When substitution with alternative antifungal medications is not an option and the initial reported reaction is an immediate reaction (other than an infusion reaction) or a delayed reaction limited to mild-moderate rash alone (i.e. not systemic reaction or organ involvement) successful desensitization has been described with various agents such as azole -oral itraconazole [18], oral fluconazole [15,17,19,86], oral voriconazole [95], intravenous voriconazole [11] and polyene antimycotic macrolides -intravenous liposomal amphotericin B [56][57][58].…”