CONTACT ALLERGY TO IMIDAZOLES USED AS ANTIMYCOTIC AGENTS

The present article reviews the literature (up to 1994) on contact sen sitivity to imidazoles and presents the results obtained from 15 patie nts observed at the Contact Allergy Unit in Leuven. The frequency as w ell as the cross-reaction patterns described are analyzed. Although al lergic contact reactions may have been missed in the past (mainly beca use of problems with the correct choice of vehicle for patch testing), they seem to be relatively infrequent in view of their widespread use . The imidazole derivatives most frequently reported to be allergens a re miconazole, econazole, tioconazole, and isoconazole. As far as cros s-reactivity is concerned, statistically significant associations were found in the patient data between miconazole, econazole, and isoconaz ole; between sulconazole, miconazole, and econazole; and also between isoconazole and tioconazole. Patients sensitive to phenylethyl imidazo les (except ketoconazole) needing antimycotic therapy should be advise d to use ketoconazole, clotrimazole, bifonazole, or, perhaps, the new flutrimazole. Clearly, non-imidazole antifungals can also be used.