Antifungal hypersensitivity reactions and cross-reactivity patterns. Issue 6 (December 2021)

• Record Type: Journal Article
• Authors: Copaescu, Ana M.; Phillips, Elizabeth J.; Trubiano, Jason A.
• Is Part Of: Current opinion in infectious diseases. Volume 34:Issue 6(2021)
• Publication Date: 2021-12
• Subjects: anaphylaxis -- antifungals -- azoles -- delayed T-cell mediated reactions -- hypersensitivity; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Review Literature -- Periodicals; 616.905
• DOI: 10.1097/QCO.0000000000000786
• Languages: English
• ISSNs: 0951-7375

Abstract

Abstract : Purpose of review: The goal of this article is to provide an updated understanding and evidence-based approach where possible for antifungal hypersensitivity. This includes recognition of clinical phenotype, implications for cross-reactivity and diagnostic, and management strategy for immediate and delayed hypersensitivity reactions. Recent findings: Antifungal hypersensitivity reactions can be classified according to their latency (immediate or delayed) and clinical phenotype. The majority of the cases described in the literature are delayed T-cell mediated reactions of various severities but immediate reactions consistent with non-Immunoglobulin E (IgE)-mediated mast cell activation and IgE-mediated reactions have also been described. Ancillary information such as skin testing, drug challenge and ex vivo experimental approaches can aid causality assessments and inform antifungal class cross-reactivity, which help optimize antifungal prescribing and stewardship. Summary: This review will update the clinician on mechanisms of drug hypersensitivity as well as providing a structured approach to the recognition, diagnosis and management of antifungal hypersensitivity reaction. Abstract : Supplemental Digital Content is available in the text