Absence of Cross-Reactivity between Sulfonamide Antibiotics and Sulfonamide Nonantibiotics

Abstract

There is an association between hypersensitivity after the receipt of sulfonamide antibiotics and a subsequent allergic reaction after the receipt of a sulfonamide nonantibiotic, but this association appears to be due to a predisposition to allergic reactions rather than to cross-reactivity with sulfonamide-based drugs.

Sulfa Allergy: Cross-Reactivity Versus Multiple Concurrent Allergies

“…As concluded by Strom et al (2003) patients with a prior sulfa allergy are even more likely to have an allergic reaction to penicillin; a structurally unrelated drug, than they are to a SNA. Additionally, the risk of an allergic reaction after receiving a SNA was higher in patients with a history of penicillin allergy than in those with a history of hypersensitivity to SA.…”

“…Most of the available evidence suggests that SNA need not to be routinely avoided in patients with a history of allergy to SA (Strom et al, 2003;Johnson et al, 2005;Brackett et al, 2004). SNA may cause an allergic reaction themselves due to stereo specificity with sulfonylarylamines, cross-reactivity though is unlikely (Brackett et al, 2004).…”

“…The cross reactivity hypothesis was tested in a large retrospective cohort study by Strom et al (2003) Authors identified 20,226 patients seen from 1987 through March 1999 who were prescribed a systemic SA and then at least 60 days later received a SNA. Researchers reviewed records to determine whether patients described as having an allergic reaction to SA were at increased risk of having a subsequent allergic reaction to SNA of 969 patients with an allergic reaction after a SA, 96 (9.9%) had an allergic reaction after receiving a SNA.…”

“…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).…”

Bosentan-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: Figure 1.

“…Looking at the summary of bosentan characteristics 8 , we found that according to the different trials, erythema may be frequent and that hypersensitivity reactions including dermatitis, pruritus, and rash are uncommon; however, the sulfonamide functional group is not stated. Although some authors suggest avoiding any sulfonamides following a history of sulfa allergy, cross-reactivity between sulfonamide antibiotics and sulfamide nonantibiotics remains a matter of debate and some arguments support the concept of overall predisposition to allergic drug reactions for some individuals rather than direct cross-reactivity 9,10 . This is the third case of hypersensitivity related to bosentan.…”