Likelihood and Mechanisms of Cross‐Allergenicity Between Sulfonamide Antibiotics and Other Drugs Containing a Sulfonamide Functional Group

  title={Likelihood and Mechanisms of Cross‐Allergenicity Between Sulfonamide Antibiotics and Other Drugs Containing a Sulfonamide Functional Group},
  author={Carolyn C. Brackett and Harleen Singh and John H. Block},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
Concerns about cross‐allergenicity between sulfonamide antibiotics and nonantibiotic, sulfonamide‐containing drugs persist and can complicate patients' drug therapy unnecessarily. No interaction between the human immune system and the sulfonamide functional group has been demonstrated. The immunologic determinant of type I, immediate hypersensitivity responses to sulfonamide antibiotics is the N1 heterocyclic ring. Nonantibiotic sulfonamides do not contain this structural feature. Non‐type I… 
Do some of the newer COX-2 inhibitors cross-react with sulfonamide antibiotics? An overview
The professional information leaflets of three locally available specific cyclooxygenase-2 inhibitors indicate that these drugs are contraindicated in persons with a known allergy to sulfonamides, and the similarity and differences in structure between the various sulfonamide medications are discussed.
Sulfonamide cross-reactivity: is there evidence to support broad cross-allergenicity?
  • N. R. Wulf, K. Matuszewski
  • Medicine
    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
  • 2013
A review of the professional literature and manufacturer-provided data did not find convincing evidence of broad cross-reactivity between antibacterial and nonantibacterial sulfonamide agents.
No proof of cross‐reactivity between celecoxib and antibiotic sulfonamides
The likelihood that hypersensitivity to celecoxib occurred because of cross-reactivity with previous (unproven) sulfonamide allergy, whereas current evidence indicates that this increased risk was conveyed just as much by a prior history of allergy to penicillin.
Cross-Reactivity in Drug Hypersensitivity Reactions to Sulfasalazine and Sulfamethoxazole
It is demonstrated that in the case of sulfamethoxazole and sulfasalazine, cross-reactivity is dependent on chemical features rather than the indication of the drugs.
Sulfa allergy: Cross-reactivity versus multiple concurrent allergies
After reviewing all the available literatur e it is concluded that assumptions about cross-reactivit y are a FICTION and an approach to use nonantibiotic sulfonamides in sulfa allergic patients is presented.
Cutaneous Adverse Events Caused by Sulfonamide-Containing Drugs: Reality or Perception?
Sulfonamide-containing compounds are not at a higher risk of presenting with a cutaneous adverse drug reaction compared with non-sulfonamides and that medicinal chemists should not avoid use of the sulfonamide group.
Hypersensitivity Reactions to Non-Beta Lactam Antibiotics
In vivo and in vitro diagnostic tests and management strategies for NBL HRs are discussed in detail to provide guidance for daily clinical practice.
Sulfonamide Allergies
For patients with an indication for a sulfonamide antimicrobial with a listed allergy, it is important for healthcare practitioners to adequately assess the allergic reaction to determine appropriate management and rechallenge and desensitization strategies may be appropriate for patients with delayed maculopapular eruptions.
Acetazolamide and sulfonamide allergy: a not so simple story.
This review addresses the differences between the groups and the propensity for intergroup and intragroup adverse reactions based on the available literature and offers a systematic approach to determine whether acetazolamide is a safe option for those with a history of allergy to sulfonamides.


Should Celecoxib Be Contraindicated in Patients Who Are Allergic to Sulfonamides?
Cross-reactivity among the various sulfonamide-containing medications has also not been substantiated by published case reports, and conflicting information exists in the literature.
Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics.
There is an association between hypersensitivity after the receipt of sulfonamide antibiotics and a subsequent allergic reaction after the receiving of a sulfonamides nonantibiotic, but this association appears to be due to a predisposition to allergic reactions rather than to cross-reactivity with sulf onamide-based drugs.
Drugs as allergens: detection and combining site specificities of IgE antibodies to sulfamethoxazole.
Practical Issues in the Management of Hypersensitivity Reactions: Sulfonamides
  • S. Tilles
  • Medicine, Biology
    Southern medical journal
  • 2001
No diagnostic tests are available to confirm sulfonamide hypersensitivity, and while avoidance of the drug is generally appropriate when a previous hypersensitivity reaction is suspected, desensitization protocols are available for use in HIV patients in whom Pneumocystis carinii pneumonia prophylaxis or treatment is indicated.
Use of optical biosensor technology to study immunological cross-reactivity between different sulfonamide drugs.
The following work offers a technique to examine in a medium-throughput system the cross-reactivity of drugs to antibodies in order to predict if structures share the same antigenic potential toward a sensitized individual.
Differences in metabolism of sulfonamides predisposing to idiosyncratic toxicity.
Susceptibility to sulfonamide reactions may be due to interaction of metabolic pathways, possibly under genetic control, regulating N-acetylation and specific detoxification of toxic metabolites of the drugs.
Studies of human IgE to a sulfonamide determinant.
Cytotoxicity of sulfonamide reactive metabolites: apoptosis and selective toxicity of CD8+ cells by the hydroxylamine of sulfamethoxazole
  • D. Hess, Margaret E. Sisson, M. Rieder
  • Biology, Chemistry
    FASEB journal : official publication of the Federation of American Societies for Experimental Biology
  • 1999
The data show that CD8+ cells are highly susceptible to the toxic effects of SMX‐HA through enhanced cell death by apoptosis, which is associated with a high incidence of adverse drug events, including severe hypersensitivity reactions.
Hypersensitivity reactions
  • E. Tan
  • Medicine, Biology
    Clinical pharmacology and therapeutics
  • 1974
The pathogenetic mechanisms by which drugs such as hydralazine and procainamide can produce autoimmune reactions are the subject of increasing interest to immunologists, since there is a possibility that understanding this reaction may lead to the elucidation of the factors that produce spontaneous autoimmune disease in man.
Fixed Drug Eruption to Rofecoxib with Cross-Reactivity to Sulfonamides
A patient who developed a rofecoxib-induced fixed drug eruption (FDE) is reported, which to the best of the authors' knowledge has not been reported earlier, and the patient was advised to discontinue the drug.