Type IV hypersensitivity to oral nystatin

Drug patch testing in systemic cutaneous drug allergy

“…Miscellaneous drugs have been reported as yielding CADR with positive drug patch tests (Barbaud et al, 1998b;Barbaud, 2003): acyclovir and valaciclovir (Lammintausta et al, 2001;Vernassiere et al, 2003), allylisopropylacetylurea in a FDE (Sakakibara et al, 2001), captopril (Barbaud et al, 1998b), cefcapene pivoxil (Kawada et al, 2001), celecoxib (Britschgi et al, 2001;Verbeiren et al, 2002), clobazam (Machet et al, 1992), codeine diluted at 1 and 5% in petrolatum (two negative controls) (Estrada et al, 2001), co-trimoxazole (Klein et al, 1995), cyamemazine (Barbaud et al, 1998b), diazepam (Felix and Comaish, 1974), diclofenac (Jonker and Bruynzeel, 2003;Romano et al, 1994), enoxoparin (Barbaud et al, 1998b), estrogens (Gonçalo et al, 1999), fluoroquinolones (Barbaud et al, 1998b;Rodriguez-Morales et al, 2001), fusafungine (Barbaud et al, 1998b), isoniazide at 50% in petrolatum (10 negative controls) (Rebello et al, 2001), Lamisil ® (Barbaud et al, 1998b), meprobamate (Barbaud et al, 2001a), metamizole at 1 and 10% in petrolatum (Gonzalo-Garijo et al, 2001;Quinones Estevez, 2001), mexiletine hydrochloride diluted at 10 and 20% in petrolatum (Sasaki et al, 2001), nystatin at 10% in petrolatum (10 negative controls) (Barranco et al, 2001), paracetamol (acetaminophen) (Mashiah and Brenner, 2003) and vancomycin at 0.005% in water (Bernedo et al, 2001).…”

Acute generalised skin rash secondary to the Nystatin Oral Suspension

“…Acute generalised exanthematous pustulosis, type IV hypersensitivity and contact dermatitis have rarely been reported in association with nystatin 3–6. Patch testing, histological examination and oral challenge test are often helpful in confirming the diagnosis 3–6. Our patient declined for both skin biopsy and patch testing; however, temporal correlation of developing skin lesions on initiating nystatin and dermatological recovery after discontinuing it confirmed the diagnosis.…”

“…Nystatin is formulated in variety of forms: capsule (for intestinal candidiasis), cream/ointment/powder (for candida diaper dermatitis), oral suspension (for oropharyngeal candidiasis), vaginal tablets (for vulvovaginal candidiasis). Acute generalised exanthematous pustulosis, type IV hypersensitivity and contact dermatitis have rarely been reported in association with nystatin 3–6. Patch testing, histological examination and oral challenge test are often helpful in confirming the diagnosis 3–6.…”

Delayed hypersensitivity to oral nystatin

“…We found a positive patch test to another polyene macrolide of similar chemical structure, amphoterin B, suggesting cross‐sensitization (8). Patch testing with macrolide antibiotics was negative as well as with the imidazole antimycotic, fluconazole.…”

“…Nevertheless, a few cases, with a dermatitis appearing within more than 1 D, with a generalized maculopapular or acute pustular exanthematic pattern, a positive oral rechallenge and positive patch tests, suggest a delayed type hypersensitivity to nystatin (4–8).…”