Should Celecoxib Be Contraindicated in Patients Who Are Allergic to Sulfonamides?

  title={Should Celecoxib Be Contraindicated in Patients Who Are Allergic to Sulfonamides?},
  author={Sandra R. Knowles and Lori E. Shapiro and Neil H. Shear},
  journal={Drug Safety},
Celecoxib, a selective cyclo-oxygenase-2 inhibitor, is a diaryl-substituted pyrazole derivative containing a sulfonamide substituent. Because of this structural component, celecoxib is contraindicated for use in patients who have demonstrated allergic reactions to sulfonamides. However, there is a lack of data demonstrating cross-reactivity among sulfonamide medications.A sulfonamide is any compound with an SO2NH2 moiety. The major difference between sulfonamide antimicrobials and other… 
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.
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.
Allergic adverse reactions to sulfonamides
Allergies to sulfonamides, particularly sulfamethoxazole (often used in combination with trimethoprim as co-trimoxazoles), are more frequent in AIDS patients, but the reason for this increased risk is not fully understood.
Likelihood and Mechanisms of Cross‐Allergenicity Between Sulfonamide Antibiotics and Other Drugs Containing a Sulfonamide Functional Group
T‐cell recognition of unmetabolized, nonhaptenated parent sulfonamide antibiotic appears to occur in a small subset of hypersensitive patients, and cross‐reactivity with nonantibiotic sulfonamides appears to remain at least theoretically possible.
Safety of Celecoxib in Individuals Allergic to Sulfonamide
This pilot study supports the hypothesis that the potential for cross-reactivity between celecoxib and sulfonamide antimicrobials appears to be low, however, further investigations are required to confirm this.
Sulfonamide allergy and cross-reactivity
  • C. C. Brackett
  • Biology, Chemistry
    Current allergy and asthma reports
  • 2007
Cellular immune responses to sulfonamide antibiotics are responsible for many non-immunoglobulin E-mediated dermatologic reactions; however, the stereospecificity of T-cell response renders cross-reactivity between sulf onamide antibiotics and nonantibiotics highly unlikely.
Not All Sulfa Drugs Are Created Equal
When assessing adverse reactions following the use of sulfa drugs, it is important to determine the chemical nature of the agent in question, the rates of similar reactions previously reported with the specific agent, and any individual susceptibilities that the patient may have to such reactions.
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.
Cross-Allergy of Sulfonamide-Containing Drugs in Sulfonamide Allergic Patients: A Literature Review and Case Study
There is minimal evidence of cross-reactivity between the antimicrobial sulfonamides and the non-antimicrobial sulf onamides, so it is impossible to say with certainty that cross- reactivity does not occur.
Do allergic reactions to sulfonamide antibiotics predict allergy to zonisamide
The stereospecific structure of ZNS is different from that of sulfonamide antibiotics, which may decrease hypersensitivity and cross-reaction significantly, and patients with intractable epilepsy and a history of rash from “sulfa” drugs may benefit from a cautious trial of Z NS.


Sulfonamide hypersensitivity and acetazolamide.
A search of the MEDLINE and TOXLINE data bases revealed more than 2000 references to acetazolamide, but not a single report of cross-sensitivity, and the manufacturer of Diamox (Lederle Laboratories) has only a few reports on file of sulfonamide-type hypersensitivity reactions to Diam ox.
Diagnosis of sulfonamide hypersensitivity reactions by in-vitro "rechallenge" with hydroxylamine metabolites.
Results suggest that the hydroxylamine derivative of sulfamethoxazole may be a reactive metabolite mediating hypersensitivity reactions to sulfonamide agents.
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.
Anticonvulsant Hypersensitivity Syndrome
Patients with anticonsvulsant hypersensitivity syndrome should avoid all aromatic anticonvulsants; benzo-diazepines, valproic acid (sodium valproate) or one of the newer anticonVulsants can be used for seizure control; however, valProic acid should be used very cautiously in the presence of hepatitis.
Drug‐induced hypothyroidism: The thyroid as a target organ in hypersensitivity reactions to anticonvulsants and sulfonamides
Patients who have sustained hypersensitivity reactions to drugs should be investigated for possible involvement of the thyroid, especially if they have low thyroxine levels, elevated levels of thyroid stimulating hormone, and autoantibodies including antimicrosomal antibodies.
Anticonvulsant hypersensitivity syndrome. In vitro assessment of risk.
Arene oxide metabolites of aromatic anticonvulsants (phenytoin, phenobarbital, and carbamazepine) may be involved in the pathogenesis of hypersensitivity reactions and cells from patients' parents exhibited in vitro toxicity that was intermediate between values for controls and patients.