Delayed onset urticaria and angioedema caused by components of itraconazole solution

ABSTRACT

Itraconazole, new triazole agent with a broader antifungal spectrum than fluconazole, has been prescribed widely in the treatment and prophylaxis for fungal infection. Itaconazole has been reported to have gastrointestinal disturbance (4%) and headache (1%) as its most common side-effects. However, allergic reactions caused by this drug are rare. A 53-year-old woman with myelodysplastic syndrome received prophylactic antibiotic therapy including itraconazole solution before chemotherapy. She complained of hive on the face with angioedema at 6 hours after taking them. The symptoms were more aggravated on the next day and reversed by stopping itraconazole solution and injection of antihistamine and steroids. Skin prick tests with itraconazole solution, itraconazole tablet, and ketoconazole showed all the negative responses. The oral challenge test with itraconazole solution was performed and resulted in urticaria and angioedema 6 hours later. Next, the oral challenge test with intraconazole tablet was performed and showed negative response. The patient was finally diagnosed as adverse reaction by additives contained intraconazole solution. We report, a case of delayed onset urticaria and angioedema caused by components of itraconazole solution.