G. Calogiuri, L. H. Garvey, E. Nettis, P. Romita, E. Di Leo, R. Caruso, L. Butani, C. Foti
{"title":"Skin Allergy to Azole Antifungal Agents for Systemic Use: A Review of the Literature.","authors":"G. Calogiuri, L. H. Garvey, E. Nettis, P. Romita, E. Di Leo, R. Caruso, L. Butani, C. Foti","doi":"10.2174/1872213X13666190919162414","DOIUrl":null,"url":null,"abstract":"BACKGROUND\nAntifungal 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.\n\n\nOBJECTIVE\nTo provide an update on the evaluation and diagnosis of skin allergy to azole antifungal agents.\n\n\nMETHODS\nThis 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.\n\n\nRESULTS\nOne 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.\n\n\nCONCLUSION\nDespite 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.","PeriodicalId":20960,"journal":{"name":"Recent patents on inflammation & allergy drug discovery","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/1872213X13666190919162414","citationCount":"10","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Recent patents on inflammation & allergy drug discovery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2174/1872213X13666190919162414","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Pharmacology, Toxicology and Pharmaceutics","Score":null,"Total":0}
引用次数: 10
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.
期刊介绍:
Recent Patents on Inflammation & Allergy Drug Discovery publishes review articles by experts on recent patents in the field of inflammation and allergy drug discovery e.g. on novel bioactive compounds, analogs and targets. A selection of important and recent patents in the field is also included in the journal. The journal is essential reading for all researchers involved in inflammation and allergy drug design and discovery.