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Fluconazole/itraconazole Urticaria and pruritus: case report A 39-year-old woman developed generalised urticaria and pruritus while receiving itraconazole. She subsequently developed a pruritic rash after fluconazole desensitisation. The woman developed generalised urticaria and pruritus while receiving itraconazole for cryptococcal pneumonitis [dosage, route and duration of treatment to reaction not stated]. Itraconazole was discontinued and the woman received amphotericin. Her history indicated and episode of mild urticaria 8 years earlier while receiving terbinafine. She had then received fluconazole, which was tolerated. She agreed to undertake a graded challenge protocol for fluconazole desensitisation. She received oral fluconazole 2 mg/mL solution every 3 hours, at increasing dosages starting from 200µg to a maximum of 120mg, followed by a 200mg tablet. Twelve hours later she received a 300mg tablet, and every 24 hours afterwards she received the target dose of 400mg, with a 6-month course of fluconazole scheduled. She received diphenhydramine and cetirizine after being discharged from hospital. She experienced a nonurticarial, fine, pruritic rash after her third daily fluconazole dose; this was treated with a temporary increase in diphenhydramine. At follow-up, she reported experiencing mild pruritus during and after showering. She continued fluconazole and appeared to be clinically improving. Rankin BT, et al. Graded challenge protocol for fluconazole hypersensitivity in a patient with cryptococcal pneumonitis. Annals of Allergy, Asthma and Immunology 108: 466, No. 6, Jun 2012. Available from: URL: http:// 803074812 dx.doi.org/10.1016/j.anai.2012.04.005 - USA

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Reactions 11 Aug 2012 No. 1414