Cross‐reactivity among p‐amino group compounds in sulfonamide fixed drug eruption: diagnostic value of patch testing

Abstract

We studied 28 patients with fixed drug eruption (FDE) caused by sulfonamide antibiotics to investigate cross-reactivity between sulfonamide derivatives and p-amino compounds and to explore the usefulness of patch testing, as an alternative to controlled oral challenge testing (COCT), in diagnosis within this clinical area. COCT with sulfamethoxazole (SMX), sulfadiazine (SDZ), sulfamethizole (SMZ), furosemide (FU), procaine (PRO) and glipizide (GPZ) was performed. Patch testing (PT) with SMX and SDZ was carried out. In all patients, the diagnosis of FDE was confirmed by positive COCT and allergy to trimethoprim ruled out by COCT. 42.8 and 31.8% of the SMX-induced FDE patients reacted to SMZ and SDZ, respectively. All patients (n = 28) tolerated FU, PRO and GPZ. COCT performed with the 3 sulfonamide antibiotics in 12 patients was positive in 2 subjects with the 3 drugs, in 2 patients only with SMX and SMZ and in the remaining 8, SMX was the only causative drug. PT was positive in 5 of 25 patients positive on COCT. The probability of obtaining a positive PT was higher among patients who had a residual lesion than that among those who lacked this. Cross-reactivity between different sulfonamide antibiotics is thus variable, being most likely between SMX and SMZ. We have found no cross-reactivity between sulfonamide antibiotics and other sulfonamide derivatives or p-amino drugs in FDE. PT is a useful tool in the diagnosis of FDE, especially if there are residual lesions, because it avoided the need for COCT in 20% of patients.

Prescribing errors in patients with documented drug allergies: comparison of ICD-10 coding and written patient notes

“…loop and thiazide diuretics, sulphonylureas, and cyclooxygenase (COX)-2 inhibitors) Z88.2 was restricted to sulphonamideantibiotics, the clinically most relevant drug class inducing allergies, while other sulphonamides are immunologically neither related nor prone to cross-reactivity [25][26][27][28]. This restriction is also in agreement with the definition of sulphonamides in Goodman and Gilman [13].…”

Study of the photostability of 18 sunscreens in creams by measuring the SPF in vitro

“…The PABA known to be very photostable [13] proves not interesting because of the allergic reactions which it is likely to cause [14,15]. Benzophenone-3, phenylbenzimidazole sulfonic acid, benzophenone-5 and methylene bis-benzotriazolyl tetramethylbutylphenol present a very good comparable photostability.…”

Sulfonamide cross-reactivity: Is there evidence to support broad cross-allergenicity?

“…These agents contain a five-or six-membered nitrogen-containing ring attached to the N1 nitrogen of the sulfonamide group and an arylamine group (H 2 N) at the N4 position of the sulfonamide group. 1,3,4,[11][12][13][14][15][16][17] The N1 and N4 substituents have been found to be predictors of immunologic response (Figures 1 and 2). The prescribing information for many of these agents includes recommendations related to sulfonamide allergy ( Table 1).…”