Immediate cross-hypersensitivity between Micafungin and Caspofungin: A case report

Abstract

A hematopoietic stem cell transplant patient with a history of immediate drug hypersensitivity reaction to micafungin was considered for a caspofungin trial. A caspofungin intradermal skin test was performed. The result was positive, suggesting the presence of cross-reactivity and that the cyclic peptide nucleus chemical structure shared between echinocandins is the site of IgE recognition. It is recommended to avoid challenging patients with history of immediate hypersensitivity to one echinocandin with another.

Antifungal hypersensitivity reactions and cross-reactivity patterns

“…Positive skin testing was also described with voriconazole using 5 mg/ml in a pediatric anaphylaxis case [11]. Positive IDT was also described (1 cm induration and 4.5 cm erythema) for caspofungin at the 0.05 mg/ml concentration in a patient that presented anaphylaxis following micafungin infusion [64]. Delayed positive SPT with undiluted concentrations was described in 3 cases of nystatin associated AGEP [61].…”

Caspofungin-induced fatal complete heart block: Another manifestation of Kounis syndrome

“…Further, the stated results from the animal models of anaphylaxis, the released mediators, and tissue targets do not reflect the same as in humans. [4] Besides there is hardly any difference between anaphylaxis and the described syndrome.…”

“…Cross-hypersensitivity has been already described between caspofungin and the brother agent micafungin. [4] Caspofungin can induce allergic reactions such as skin rash, erythematous and purpuric macules and skin exfoliation, blisters and erosions resembling toxic epidermal necrolysis. [5] The authors of this report correctly commented on histamine releasing capacity of caspofungins.…”

Spanish Society of Allergology and Clinical Immunology (SEAIC) Vision of Drug Provocation Tests

“…As a Fixed Drug Eruption is the most frequent reported symptom, patch tests have to be performed not only with the culprit drug to confirm the diagnosis, but also, with other family members to discard cross-reactivity before the DPT [167][168][169][170][171][172][173]. Cross-reactivity is not well described in the antifungal group, and there are several clinical reports with different results between members of the same family [167][168][169][170][171][172][173][174].…”