Antifungal hypersensitivity reactions and cross-reactivity patterns

Curr Opin Infect Dis. 2021 Dec 1;34(6):559-572. doi: 10.1097/QCO.0000000000000786.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antifungal Agents* / adverse effects
  • Cross Reactions
  • Drug Hypersensitivity* / diagnosis
  • Drug Hypersensitivity* / etiology
  • Humans
  • Immunoglobulin E
  • Skin Tests

Substances

  • Antifungal Agents
  • Immunoglobulin E