Ketoconazole is a synthetic imidazole-derivative antifungal agent used in the treatment of systemic and subcutaneous mycosis; also effective in the treatment of dermatophytosis and superficial mycosis.
Very low (4 cases published).
Clinical manifestations
Anaphylactic shock.
Pruritus, rash, urticaria, facial angioedema.
Diagnostic methods
Cutaneous testing
Skin-prick tests with 1, 10, 20, 40 mg/ ml positive with a concentration of 10 mg/ ml in a patient with allergic reaction to ketoconazole.
No specific IgE found.
Histamine release test was positive in the same patient.
Oral challenge: 25 mg, 50 mg, 100 mg, 200 mg positive in the same patient following a cumulative dose of 75 mg.
IgE-mediated hypersensitivity is likely.
Cross-reactivity with other azole derivatives is possible, but not demonstrated.


  1. Beal M, Bernard C, Zenut M, Simmonnet F, Lavarenne J, Boch C, "Reaction anaphylactique au ketoconazole", Therapie., 1996 ; 51 (5): 604-5
  2. Gonzalez-Delgado P, Florido-Lopez F, Saenz de San Pedro B, Cuevas-Agusti M, Marin-Pozo J.F,"Hypersensitivity to ketoconazole", Ann. Allergy., 1994 ; 73 (4): 326-8

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.