sulfa allergy
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Epidemiology
- about 3% of patients develop allergic reactions to sulfonamides (sulfonylarylamines, the sulfa antibiotics)[4]
Clinical manifestations
- hypersensitivity*
- most reactions are mild, i.e. urticaria
- anaphylaxis
- Stevens-Johnson syndrome
* PEN-FAST (SULF-FAST) criteria for predicting sulfonamide hypersensitivity[6]
- allergic event occurred <+ 5 years ago (2 points)
- event was anaphylaxis/angioedema or severe cutaneous adverse reaction (2 points)
- treatment was required for allergic event (1 point)
* a PEN-FAST (SULF-FAST) of <3 associated with <5% risk of hypersensitivity reaction
- a score >= 3 associated with >20% risk of hypersensitivity reaction[6]
Management
- Cross reactivity of non antibiotic sulfa drugs is rare, thus use of non-antibiotic sulfonamides is not contraindicated*[4][7]
- zonisamide (Zonegran) -> contraindicated
- sulfasalazine (Azulfidine) -> avoid
- thiazide diuretics are not contraindicated
- loop diuretics are not contraindicated
- celecoxib is not contraindicated
- use with caution in patients with severe sulfa reactions
- amprenavir (Agenerase) is a sulfonamide (use with caution)
- carbonic anhydrase inhibitors (insufficient data)
- COX-2 inhibitors celecoxib (Celebrex) & valdecoxib (Bextra)[3]
- insufficient data
- still contraindicated
- sulfonylureas
- cross-reactivity of sulfonamide antibiotics & sulfonylureas is rare[5]
- no reports of cross-sensitivity with glipizide (Glucotrol)
- rare reports of cross-reaction with glyburide (Diabeta, Micronase) & tolbutamide (Orinase)
- sumatriptan, sotalol, topiramate ?[4]
- saccharin
- drugs that contain sulfur, but are NOT sufonamides are okay for patients allergic to sulfonamides:
* Sulfonamide antibiotic reactions probably confer increased risk for drug reaction with non-antibiotic sulfonamides as a result of increased susceptibility to drug reactions rather than cross-reactivity of sulfonamides[2]
More general terms
Additional terms
References
- ↑ Prescriber's Letter 7(7):37 2000
- ↑ 2.0 2.1 Strom BL et al, N Engl J Med 349:1628, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14573734
- ↑ 3.0 3.1 Prescriber's Letter 11(7):42 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200702&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 4.2 4.3 Prescriber's Letter 11(7):42 2004 Sulfa Drugs and the Sulfa-allergic Patient Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211113&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 NEJM Knowledge+ Endocrinology
- ↑ 6.0 6.1 6.2 Waldron JL et al. Development and validation of a sulfa antibiotic allergy clinical decision rule. JAMA Netw Open 2023 Jun 5; 6:e2316776. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37273210 PMCID: PMC10242418 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805577
- ↑ 7.0 7.1 NEJM Knowledge+ Allergy/Immunology
Dorn JM, Alpern M, McNulty C, Volcheck GW. Sulfonamide Drug Allergy. Curr Allergy Asthma Rep. 2018 Jun 6;18(7):38. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29876667 Review.
Khan DA, Knowles SR, Shear NH. Sulfonamide Hypersensitivity: Fact and Fiction. J Allergy Clin Immunol Pract. 2019 Sep-Oct;7(7):2116-2123. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31495421 Review.