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There is minimal evidence of cross-reactivity between sulfonamide antibiotics and non-antibiotics [1-4]. Despite this, the U.S. FDA-approved product information for many non-antibiotic sulfonamide drugs contains warnings concerning possible cross-reactions.
Key Findings from a New Review Article [5]:
- An estimated 3-6% of the general population is allergic to sulfonamides.
- Structurally, none of the non-antibiotic sulfonamides exhibit both of the features shown to be responsible for sulfonamide reactions (i.e., an N-containing ring attached to the N1 nitrogen of the sulfonamide group and an arylamine group at the N4 position).
- A comprehensive literature search (1966-December 2011) identified only 9 case reports indicating possible cross-reactivity to sulfonamide medications; however, in most cases, adequate patient testing was not conducted to firmly establish either sulfa allergy or sulfonamide cross-sensitivity.
Bottom line: You can feel safe prescribing furosemide, glyburide, and hydrochlorothiazide to your patient with an allergy to sulfamethoxazole/trimethoprim.
Other blog reference on this topic: http://lifeinthefastlane.com/2011/04/sulfa-drug-discombobulation/
References
- Strom BL, et al. Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics. N Engl J Med 2003;349(17):1628-35. [PMID 14573734]
- Hemstreet BA, et al. Sulfonamide allergies and outcomes related to use of potentially cross-reactive drugs in hospitalized patients. Pharmacotherapy 2006;26(4):551-7. [PMID 16553515]
- Lee AG, et al. Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? Am J Ophthalmol 2004;138(1):114-8. [PMID 15234289]
- Johnson KK, et al. Sulfonamide cross-reactivity: fact or fiction? Ann Pharmacother 2005;39(2):290-301. [PMID 15644481]
- Wulf NR, et al. Sulfonamide cross-reactivity: Is there evidence to support broad cross-allergenicity? Am J Health-Syst Pharm 2013;70(17):1483-94. [PMID 23943179]
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