Sulfonamide Allergy

Aka: Sulfonamide Allergy, Sulfa Allergy

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II. Pharmacology

  1. Hypersensitivity to Sulfonamide groups most affects Sulfonylarylamines, but can affect Non-Sulfonylarylamines and Sulfonamide Moieties
  2. Sulfonamide Allergy does NOT cross react with sulfur, sulfate, Sulfites (e.g. Morphine Sulfate, Clopidogrel bisulfate)

III. Preparations: 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. Preparations: 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. Preparations: 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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