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Immediate cross-hypersensitivity between micafungin and caspofungin: a case report.
Shruti Patel1, George J Alangaden, Larry G Lum
1Wayne State University, Detroit, MI, USA.
Summary
Patients with a history of micafungin hypersensitivity may also react to caspofungin. This cross-reactivity suggests shared chemical structures in echinocandins trigger allergic reactions. Avoid using one echinocandin after a reaction to another.
Area of Science:
- * Clinical Immunology
- * Pharmacology
- * Infectious Diseases
Background:
- * Hematopoietic stem cell transplant (HSCT) patients often require antifungal therapy.
- * Immediate hypersensitivity reactions (IHR) to echinocandins, like micafungin, can complicate treatment.
- * Echinocandins share a common cyclic peptide nucleus structure.
Observation:
- * An intradermal skin test with caspofungin was performed in a patient with a known micafungin IHR.
- * The caspofungin skin test yielded a positive result.
- * This positive reaction indicated potential cross-reactivity between micafungin and caspofungin.
Findings:
- * The positive skin test suggests IgE-mediated cross-reactivity between micafungin and caspofungin.
- * The shared cyclic peptide nucleus of echinocandins is implicated as the likely epitope for IgE recognition.
- * Cross-reactivity among echinocandins is a significant clinical consideration.
Implications:
- * Clinicians should exercise caution when prescribing a different echinocandin to patients with a documented IHR to one agent.
- * Alternative antifungal classes may be necessary for patients with a history of echinocandin hypersensitivity.
- * Further research into the immunogenic epitopes of echinocandins is warranted to predict and prevent cross-reactivity.
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