Which antifungal should be avoided in patients with a history of hypersensitivity to azoles?

Voriconazole is an antifungal that belongs to the azole class of medications. Patients with a history of hypersensitivity to azoles should avoid it due to the potential for serious allergic reactions or adverse effects. This class of drugs works by inhibiting the synthesis of ergosterol, an essential component of fungal cell membranes, and since voriconazole shares a similar chemical structure and mechanism of action with other azoles, it can provoke a hypersensitivity response in individuals already allergic to one azole.

Fluconazole and ketoconazole are also azoles and would pose a similar risk of cross-reactivity for patients with a known azole hypersensitivity. Terbinafine, on the other hand, is a different class of antifungal known as an allylamine and does not share the same structure or mechanism as azoles, making it a safer alternative for these patients. Thus, voriconazole is specifically contraindicated in those with a history of hypersensitivity to azoles due to the likelihood of similar allergic reactions.