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Sulfonamide cross-reactivity: fact or fiction?
Kelly K Johnson1, David L Green, Jason P Rife
1Adult Internal Medicine Pharmacy Resident, Department of Pharmacy Services, Virginia Commonwealth University Medical Center-Medical College of Virginia (MCV) Campus, Richmond, VA 23298-0042, USA.
The Annals of Pharmacotherapy
|January 13, 2005
Summary
The dogma of sulfonylarylamine cross-reactivity with non-sulfonylarylamines is not supported by available data. Case reports often lack conclusive evidence to establish a definitive link or association.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Drug Hypersensitivity
Background:
- Cross-reactivity between sulfonylarylamines and non-sulfonylarylamines is a commonly accepted clinical principle.
- This principle is often cited in drug information and patient counseling regarding sulfonamide allergies.
Purpose of the Study:
- To critically review the scientific literature supporting the concept of cross-reactivity between sulfonylarylamines and non-sulfonylarylamines.
- To evaluate the quality of evidence presented in case reports and observational studies.
Main Methods:
- A comprehensive literature search was performed using MEDLINE/PubMed (1966-March 2004).
- Included search terms were individual medications, drug hypersensitivity, sulfonamides, and cross-reaction.
- Manufacturer's package inserts were reviewed, and manufacturers were contacted for supporting clinical data.
Main Results:
- 33 medications were identified, with 17 (51.5%) package inserts containing statements regarding use in patients with sulfonamide allergy.
- 21 case series, case reports, and other articles were found and critically reviewed.
Conclusions:
- The widely held belief in sulfonylarylamine cross-reactivity with non-sulfonylarylamines is not substantiated by the current literature.
- Many case reports, while seemingly supportive, lack the rigorous evidence to conclusively establish a causal link or association.