Sulfonamide Allergy

Aka: Sulfonamide Allergy, Sulfa Allergy, SULF-FAST

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II. Mechanism

  1. Hypersensitivity to Sulfonamide groups most affects Sulfonylarylamines
    1. Can affect Non-Sulfonylarylamines and Sulfonamide Moieties
  2. Sulfonamide Allergy does NOT cross react with sulfur, sulfate, Sulfites (e.g. Morphine Sulfate, Clopidogrel bisulfate)
  3. SULF-FAST
    1. Indicated in decision to re-challenge Sulfonamide exposure
    2. Criteria
      1. Score 2+: Reaction in last 5 years (or unknown)
      2. Score 2+: Moderate to severe prior reaction
        1. Anaphylaxis
        2. Angioedema
        3. Severe cutaneous adverse reaction (e.g. SJS, TEN, DRESS, AGEP)
      3. Score 1+: Reaction required treatment
    3. Interpretation
      1. Score <3: Low Risk for reaction
        1. Oral trial may be considered
      2. Score >=3: Increased risk of reaction
        1. Consider allergy/Immunology referral, Skin Testing
    4. References
      1. Waldron (2023) JAMA Netw Open 6(6):e2316776 +PMID: 37273210 [PubMed]

III. Medications: Sulfonylarylamines (Sulfa agents)

  1. General
    1. Typical sulfa-allergens, with greatest cross-reactivity to other sulfa agents
  2. Sulfa Antibiotics
    1. Trimethoprim-Sulfamethoxazole (Bactrim, Sulfatrim, Co-trimoxazole, Septra)
    2. Sulfadiazine
    3. Sulfacetamide
    4. Sulfapyridine
  3. Sulfa Antiinflammatories
    1. Sulfasalazine (metabolized to sulfapyridine)
  4. Protease Inhibitors (HIV Infection)
    1. Amprenavir
    2. Darunavir (Prezista)
    3. Fosamprenavir (Lexiva)
    4. Tipranavir
    5. Simeprevir (Olysio, for Hepatitis C Infection)

IV. Medications: Non-Sulfonylarylamines

  1. General
    1. Similar structure to Sulfonylarylamines , but Hypersensitivity cross-reactivity is uncommon
    2. However, do not use non-Sulfonylarylamines if history of Anaphylaxis or Erythema Multiforme Major to sulfa agents
  2. Diuretics
    1. All Thiazide Diuretics
    2. Some Loop Diuretics (Furosemide, Torsemide, Bumetanide)
    3. Carbonic Anhydrase Inhibitors (e.g. Acetazolamide)
  3. Anti-hyperglycemics (Diabetes Mellitus)
    1. Sulfonylureas (e.g. Glipizide)
  4. Analgesics
    1. COX-2 Inhibitors (e.g. Celecoxib or Celebrex)

V. Medications: Sulfonamide Moieties

  1. General
    1. Differ significantly from Sulfonylarylamines (despite both having Sulfonamide group)
    2. However, do not use non-Sulfonylarylamines if history of Anaphylaxis or Erythema Multiforme Major to sulfa agents
  2. Neurologic agents
    1. Triptans (e.g. Sumatriptan or Imitrex)
    2. Topiramate (Topamax)
    3. Zonisamide (Zonagran)
  3. Miscellaneous agents
    1. Tamsulosin (Flomax)
    2. Probenecid

VI. References

  1. (2014) Presc Lett 21(2): 10-11
  2. (2022) Presc Lett 29(10): 55-6
  3. Ghimire (2013) J Clin Pharm Ther 38: 196–202 [PubMed]
  4. Giles (2019) Pharmacy 7(3):132 +PMID: 31514363 [PubMed]
  5. Wulf (2013) Am J Health Syst Pharm 70:1483-94 [PubMed]

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