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

Wayne State University, Detroit, MI, USA

George J Alangaden, MD

Department of Internal Medicine, Infectious Disease Division, Wayne State University, Detroit, MI, USA

Larry G Lum, MD

Immmunotherapeutics Laboratory, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA;

Simon M Cronin, MS PharmD

Department of Pharmacy, Karmanos Cancer Institute, Eugene Applebaum College of Pharmacy and Allied Health Professions, Wayne State University, 4100 John R, Detroit, MI 48201, USA

Muneer H Abidi, MD

Bone Marrow Transplantation Service, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI, USA

Natalie Dieterle, PA-C

Bone Marrow Transplantation Service, Karmanos Cancer Institute, School of Medicine, Wayne State University, Detroit, MI, USA

Rami B Ibrahim, MSc PharmD BCPS BCOP

Department of Pharmacy/Karmanos Cancer Hospital, Adjunct-Assistant Professor, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Allied Health Professions and the School of Medicine, Wayne State University, 4100 John R, Detroit, MI 48201, USA, ibrahim{at}karmanos.org

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.

Key Words: echinocandin • cross-reactivity • hypersensitivity • micafungin • caspofungin

This version was published on September 1, 2009

Journal of Oncology Pharmacy Practice, Vol. 15, No. 3, 187-189 (2009)
DOI: 10.1177/1078155208101122


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