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Skin Allergy to Azole Antifungal Agents for Systemic Use: A Review of the Literature.

Abstract

BACKGROUND

Antifungal azoles are the first-line agents used to treat topical and, above all, systemic mycosis. The latter could be life-threating infections in immunocompromised patients. Chemotherapeutic antibiotics, including antifungal azoles, may induce hypersensitivity reactions; however, such immunologic adverse reactions have not been as well defined and carefully investigated.

OBJECTIVE

To provide an update on the evaluation and diagnosis of skin allergy to azole antifungal agents.

METHODS

This is a systematic review performed on PubMed and Google Schoolbarusing the key term "allergy, hypersensitivity, anaphylaxis, immediate-type reaction, delayed-type reaction, ketoconazole, fluconazole, posaconazole, voriconazole, itravuconazole, triazoles, imidazoles, antifungals, antimycotics"The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, reviews and case reports.

RESULTS

One hundred twenty-four articles matched our search terms. The most common adverse events reported were T-cell mediateddelayed-type hypersensitivity reactions, such as fixed drug eruptions,localized, generalized and exhantematous dermatitis, Steven Johnson syndrome, toxic epidermal necrolysis and acute generalizedexhanthematouspustulosis. Rarely a drug rash, eosinophilia systemic symptoms has been described Also immediate-type reactions such as urticaria-angioedema or anaphylaxis have been reported following administration of antifungal imidazoles, although not so frequently.

CONCLUSION

Despite their widespread use, triazoles seem to induce rare cutaneous hypersensitivity reactions, but the pathomechanisms, risk factors, diagnostic and management strategies, including skin tests and challenge tests, are little known and poorly investigated.

Authors+Show Affiliations

Department of Pneumology and Allergy Hospital SacroCuore - Gallipoli (Lecce). Italy.Allergy Clinic, Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, . Denmark.Department of Biomedical Sciences and Human Oncology Unit of Internal Medicine "G. Baccelli", "Aldo Moro" University of Bari Medical School, Policlinico, Bari. Italy.Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari. Italy.Section of Allergy and Clinical Immunology, Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva delle Fonti, Bari. Italy.Clinica Salus - Brindisi. Italy.Section of Pediatric Nephrology, Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA. United States.Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari. Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31538908

Citation

Calogiuri, Gianfranco, et al. "Skin Allergy to Azole Antifungal Agents for Systemic Use: a Review of the Literature." Recent Patents On Inflammation & Allergy Drug Discovery, 2019.
Calogiuri G, Garvey LH, Nettis E, et al. Skin Allergy to Azole Antifungal Agents for Systemic Use: A Review of the Literature. Recent Pat Inflamm Allergy Drug Discov. 2019.
Calogiuri, G., Garvey, L. H., Nettis, E., Romita, P., Di Leo, E., Caruso, R., ... Foti, C. (2019). Skin Allergy to Azole Antifungal Agents for Systemic Use: A Review of the Literature. Recent Patents On Inflammation & Allergy Drug Discovery, doi:10.2174/1872213X13666190919162414.
Calogiuri G, et al. Skin Allergy to Azole Antifungal Agents for Systemic Use: a Review of the Literature. Recent Pat Inflamm Allergy Drug Discov. 2019 Sep 19; PubMed PMID: 31538908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Skin Allergy to Azole Antifungal Agents for Systemic Use: A Review of the Literature. AU - Calogiuri,Gianfranco, AU - Garvey,Lene H, AU - Nettis,Eustachio, AU - Romita,Paolo, AU - Di Leo,Elisabetta, AU - Caruso,Riccardo, AU - Butani,Lavjay, AU - Foti,Caterina, Y1 - 2019/09/19/ PY - 2018/11/28/received PY - 2019/09/06/revised PY - 2019/09/06/accepted PY - 2019/9/21/entrez KW - Allergy KW - antifungals KW - dermatitis KW - hypersensitivity KW - imidazoles KW - rash KW - triazoles JF - Recent patents on inflammation & allergy drug discovery JO - Recent Pat Inflamm Allergy Drug Discov N2 - BACKGROUND: Antifungal azoles are the first-line agents used to treat topical and, above all, systemic mycosis. The latter could be life-threating infections in immunocompromised patients. Chemotherapeutic antibiotics, including antifungal azoles, may induce hypersensitivity reactions; however, such immunologic adverse reactions have not been as well defined and carefully investigated. OBJECTIVE: To provide an update on the evaluation and diagnosis of skin allergy to azole antifungal agents. METHODS: This is a systematic review performed on PubMed and Google Schoolbarusing the key term "allergy, hypersensitivity, anaphylaxis, immediate-type reaction, delayed-type reaction, ketoconazole, fluconazole, posaconazole, voriconazole, itravuconazole, triazoles, imidazoles, antifungals, antimycotics"The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, reviews and case reports. RESULTS: One hundred twenty-four articles matched our search terms. The most common adverse events reported were T-cell mediateddelayed-type hypersensitivity reactions, such as fixed drug eruptions,localized, generalized and exhantematous dermatitis, Steven Johnson syndrome, toxic epidermal necrolysis and acute generalizedexhanthematouspustulosis. Rarely a drug rash, eosinophilia systemic symptoms has been described Also immediate-type reactions such as urticaria-angioedema or anaphylaxis have been reported following administration of antifungal imidazoles, although not so frequently. CONCLUSION: Despite their widespread use, triazoles seem to induce rare cutaneous hypersensitivity reactions, but the pathomechanisms, risk factors, diagnostic and management strategies, including skin tests and challenge tests, are little known and poorly investigated. SN - 1872-213X UR - https://www.unboundmedicine.com/medline/citation/31538908/Skin_Allergy_to_Azole_Antifungal_Agents_for_Systemic_Use:_A_Review_of_the_Literature DB - PRIME DP - Unbound Medicine ER -