Cross‐reactivity between voriconazole, fluconazole and itraconazole

Summary What is known and objective Hypersensitivity to triazoles is a rare occurrence and cross‐reactivity between agents is unknown. We present a successful voriconazole challenge in a patient allergic to fluconazole and itraconazole. Case summary A 41‐year‐old immunocompetent male with coccidioidomycosis developed fever, eosinophilia and maculopapular rash from fluconazole. Switching to itraconazole resulted in worsening of the rash and skin sloughing over 25% of his body. He was given an oral‐graded challenge of voriconazole which he tolerated without incident. What is new and conclusion This is the first report of a lack of cross‐reactivity between itraconazole and voriconazole.