Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
The University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Pediatr Allergy Immunol Pulmonol. 2021 Sep;34(3):106-108. doi: 10.1089/ped.2020.1204. Epub 2020 Jul 21.
Echinocandin antifungal medications including micafungin are being used more commonly in the treatment of invasive fungal infections in both pediatric and adult patients. Micafungin is also a first-line therapeutic option for candidemia and antifungal prophylaxis in a variety of clinical settings. Hypersensitivity reactions have not been well described; however, isolated cases have been reported. No cases of desensitization to echinocandins have been previously described. In this report, we described a 14-year-old female with high-risk pre-B cell acute lymphoblastic leukemia diagnosed with pulmonary aspergillosis. She developed a hypersensitivity reaction to micafungin, which was deemed first-line therapy for the infection. A rapid intravenous desensitization protocol was successfully completed without reactions. The patient completed the remaining 2 months of therapy without reactions. This report outlines the first report of a successful desensitization to micafungin or any echinocandin. This is a safe method of completing antifungal therapy in a patient with echinocandin hypersensitivity and may be considered for other patients with micafungin hypersensitivities.
棘白菌素类抗真菌药物（包括米卡芬净）在儿科和成人侵袭性真菌感染的治疗中越来越常用。米卡芬净也是念珠菌血症和多种临床情况下抗真菌预防的一线治疗选择。过敏反应尚未得到很好的描述；然而，已有孤立病例报告。以前没有描述过对棘白菌素类药物脱敏的病例。在本报告中，我们描述了一名 14 岁女性，患有高危前 B 细胞急性淋巴细胞白血病，被诊断为肺部曲霉菌病。她对米卡芬净产生了过敏反应，而米卡芬净被认为是该感染的一线治疗药物。快速静脉脱敏方案成功完成，无反应。患者在没有反应的情况下完成了剩余的 2 个月治疗。本报告概述了首例成功脱敏至米卡芬净或任何棘白菌素类药物的病例。这是一种在对棘白菌素类药物过敏的患者中完成抗真菌治疗的安全方法，也可考虑用于其他对米卡芬净过敏的患者。
