Sulfonamide Cross-Reactivity: Fact or Fiction?

Abstract

After a thorough critique of the literature, it appears that the dogma of sulfonylarylamine cross-reactivity with non-sulfonylarylamines is not supported by the data. While many of the case reports on the surface support the concept of cross-reactivity, on closer examination the level of evidence in many of the cases does not conclusively support either a connection or an association between the observed cause and effect.

Sulfa Allergy: Cross-Reactivity Versus Multiple Concurrent Allergies

“…Finally, in an exhaustive review of all the relevant case reports from 1955 to Johnson et al (2005 concluded that, none of the drug pairs implicated during this 50-year period showed enough strength of association to establish the existence of sulfonamide cross-reactivity.…”

“…Based on these findings authors concluded that the risk of cross-reactivity between SA and celecoxib is low. Based on this review Johnson et al (2005) made the recommendation that patients with a sulfonylarylamine allergy can be administered medications from the other two groups with proper monitoring if it is not possible to use an unrelated product.…”

“…One being an IgE mediated maculopapular or urticarial rash developing 1-3 days after medication initiation and the other being a hypersensitivity reaction. The hypersensitivity reaction, consisting of fever and non-urticarial rash, usually develops 7-14 days after the medication initiation (Johnson et al, 2005). The term "sulfa" refers to a derivative of an antimicrobial agent, sulfanilamide.…”

“…The term "sulfa" refers to a derivative of an antimicrobial agent, sulfanilamide. The term has been applied to a diverse group of drugs, all of which contain the sulfonamide chemical structure; -SO2NH2 moiety which is also a part of many common medications, such as thiazide and loop diuretics (Johnson et al, 2005). We can classify sulfa drugs in two ways, one is based on the chemical structure i.e., sulfonylartylamine, non sulfonylarylamine and sulfonamide moiety containing drugs ( Fig.…”

“…We can classify sulfa drugs in two ways, one is based on the chemical structure i.e., sulfonylartylamine, non sulfonylarylamine and sulfonamide moiety containing drugs ( Fig. 1) (Johnson et al, 2005) and the other is based on cross reactivity theory i.e., Sulfonamides Antibiotics (SA) and Sufonamides Non-Antibiotics (SNA) ( Table 1A) (Strom et al, 2003).…”