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Antifungal hypersensitivity reactions and cross-reactivity patterns

Copaescu, A.M., Phillips, E.J. and Trubiano, J.A. (2021) Antifungal hypersensitivity reactions and cross-reactivity patterns. Current Opinion in Infectious Diseases, 34 (6). pp. 559-572.

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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.


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.

Item Type: Journal Article
Murdoch Affiliation(s): Institute for Immunology and Infectious Diseases
Publisher: Lippincott Williams & Wilkins Ltd.
Copyright: © 2021 Wolters Kluwer Health
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