Maternal Allergy to Fluconazole—An Unusual Presentation: Case Report in a Breastfeeding Mother

TL;DR

A breastfeeding mother had an allergic reaction to a single dose of fluconazole used to treat her baby's thrush, but symptoms quickly improved with antihistamines and did not affect breastfeeding.

Contribution

Reports a rare case of maternal fluconazole allergy during breastfeeding and highlights the importance of allergy history and counseling.

Findings

A mother developed angioedema and urticarial rash after a single dose of fluconazole for neonatal thrush.

Symptoms resolved rapidly with antihistamines and did not impact breastfeeding.

The case underscores the need for allergy history and counseling before prescribing antifungals to breastfeeding mothers.

Abstract

What are the main findings?
Hypersensitive reaction to a single dose of Diflucan administered as part of treatment of neonatal thrush.Angioedema, periorbital swelling, urticarial rash on face, neck, upper chest and lips.Rapid response to antihistamines.

Hypersensitive reaction to a single dose of Diflucan administered as part of treatment of neonatal thrush.

Angioedema, periorbital swelling, urticarial rash on face, neck, upper chest and lips.

Rapid response to antihistamines.

What are the implications of the main findings?
A thorough history should be taken before placing a mother on antifungal agents.Counselling should include possible allergic reactions.Treatment results in quick response and does not affect lactation.

A thorough history should be taken before placing a mother on antifungal agents.

Counselling should include possible allergic reactions.

Treatment results in quick response and does not affect lactation.

Background: Allergy to fluconazole is uncommon and even more so in lactating women receiving treatment as part of treatment for neonatal oral thrush. Methods: We report a case of a rare and unexpected adverse reaction occurring after a single dose of fluconazole (Diflucan), administered to a mother of an exclusively breastfed neonate with oral thrush, as per guideline recommendations. Results: The woman developed multiple symptomatic manifestations highly suspicious of a hypersensitivity reaction after 8 h of taking a single 150 mg dose which were managed with antihistamines and cessation of medication. The baby’s symptoms abated with treatment and the mother whose hypersensitivity symptoms abated with treatment continued to breastfeed. Conclusion: We recommend that in prescribing antifungals to women whose babies have neonatal oral thrush, clinicians must always bear in mind that a history of previous allergic reaction(s) could signal the possibility of an allergic reaction to the antifungal agent. Counselling should therefore include the potential for reactions and steps to take if these develop. With supportive treatment, appropriate therapies and cessation of the medication, these invariably resolve. Where these persist, offering topical antifungal options may minimize the risk of recurrence of the hypersensitivity.