The management of patients with sulfonamide allergy

To illustrate the variety of clinical strategies that may be used in treatment of patients allergic to sulfa medications, we report the management of eight sulfa allergic patients, seven of whom required readministration of the sulfa drug. Slow oral readministration of a sulfonamide over the course of four weeks was successful in two patients who had a history of cutaneous reactions to sulfa use and did not require sulfa urgently. Rapid oral or intravenous readministration of a sulfonamide was attempted unsuccessfully in three patients, each of whom urgently needed continuation of a sulfa drug. Occasionally a sulfa drug must be continued despite the presence of a cutaneous drug eruption secondary to that drug. In four patients, including two of the patients in whom rapid test dosing of a sulfonamide had been unsuccessful, treatment of the sulfa reaction with corticosteroids and antihistamines permitted continued sulfa administration. Readministration of a sulfonamide should not be attempted in patients who previously have had reactions such as Stevens-Johnson syndrome unless essential for survival of a patient.