Fluconazole‐induced fixed drug eruption confirmed by extemporaneous patch testing

Khan, Manoranjan; Paul, Nsirimobu Ichendu; Fernandez, Carolina; Wakelin, S. H.

doi:10.1111/cod.13640

Cited by 6 publications

(9 citation statements)

References 10 publications

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“…However, the sensitivity of drug patch testing is variable, 7 and often oral provocation tests are required, which can fully reactivate the eruption 6 . To date, there are a total of 28 previously published case reports on fluconazole‐induced FDEs listed on MEDLINE 1,6 . However, the fluconazole patch reactivity rate in FDE is low at only 27%, according to recent reports 1 …”

Section: Discussionmentioning

confidence: 99%

“…To date, there are a total of 28 previously published case reports on fluconazole‐induced FDEs listed on MEDLINE 1,6 . However, the fluconazole patch reactivity rate in FDE is low at only 27%, according to recent reports 1 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…Fluconazole, a triazole antifungal agent, is commonly used in the treatment of vulvovaginal candidiasis 1 . Whilst fluconazole is rarely associated with fixed drug eruptions (FDE), some cases have been reported in the literature 1,2 . In FDE, patch testing has reported utility, 3 and is conventionally performed on residual pigmented lesional sites 4 .…”

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confidence: 99%

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Bullous fixed drug eruption induced by fluconazole: Importance of multi‐site lesional patch testing

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Bullous fixed drug eruption induced by fluconazole: Importance of multi‐site lesional patch testing

et al. 2020

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“…In smaller studies, high rates of positivity to piroxicam (85.7% in one study, 6 of 7 patients) [69] and antibiotics (beta-lactams, fluoroquinolones and sulfonamides) (50%, corresponding to 4 of 8 patients) have also been reported [61]. There are numerous case reports of patch test positivity in the setting of FDE to other drugs, including fluconazole [70][71][72], adalimumab [73], etoricoxib [74][75][76][77][78], piroxicam [69,79,80], nimesulide [81][82][83], and contrast medium [84,85].…”

Section: Fixed Drug Eruption (Fde)mentioning

confidence: 99%

The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications

Woodruff

Botto

2022

Clinic Rev Allerg Immunol

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Confirming drug imputability is an important step in the management of cutaneous adverse drug reactions (CADR). Re-challenge is inconvenient and in many cases life threatening. We review the literature on ideal patch testing technique for specific CADRs. Testing should be performed approximately 3 months after the resolution of the eruption using standard patch testing techniques. Commercially available patch test preparations are available for a minority of drugs, so in most cases, testing should be performed with the drug at various recommended concentrations and in different vehicles. Testing to all known excipients, such as dyes, vehicles and preservatives is also important. Immunosuppressive medications should be discontinued or down titrated to the lowest tolerable dose to decrease the risk of false negative reactions. We provide an overview of expert recommendations and extant evidence on the utility of patch testing for identifying the culprit drug in common CADRs and for specific drug or drug classes. Overall, there appears to be significant variability in the patch test positivity of different drugs, which is likely the result of factors intrinsic to the drug such as dermal absorption (as a function of lipophilicity and molecular size) and whether the drug itself or a downstream metabolite is implicated in the immune reaction. Drugs with high patch test positivity rates include beta-lactam antibiotics, aromatic anticonvulsants, phenytoin, and corticosteroids, among others. Patch testing positivity varies both as a function of the drug and type of CADR. The sum of the evidence suggests that patch testing in the setting of morbilliform eruptions, fixed drug eruption, acute generalized exanthematous pustulosis, and possibly also drug-induced hypersensitivity syndrome, photoallergic and eczematous reactions may be worthwhile, although utility of testing may vary on the specific drug in question for the eruption. It appears to be of limited utility and is not recommended in the setting of other complex CADR, such as SJS/TEN and leukocytoclastic vasculitis.

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Antifungal hypersensitivity reactions and cross-reactivity patterns

Copaescu

Phillips

Trubiano

2021

Current Opinion in Infectious Diseases

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Purpose of reviewThe 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 findingsAntifungal 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.

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Fluconazole‐induced fixed drug eruption confirmed by extemporaneous patch testing

Abstract: Wakelin S. Fluconazole-induced fixed drug eruption confirmed by extemporaneous patch testing.

Cited by 6 publications

References 10 publications

Bullous fixed drug eruption induced by fluconazole: Importance of multi‐site lesional patch testing

Bullous fixed drug eruption induced by fluconazole: Importance of multi‐site lesional patch testing

The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications

Antifungal hypersensitivity reactions and cross-reactivity patterns

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