The Role of In Vivo, In Vitro and Pharmacogenomic Diagnostic Approaches to Sulfonamide Allergy

Sulfonamide antibiotics are commonly reported as a medication allergy, presenting as both immediate IgE-mediated reactions and delayed hypersensitivity reactions ranging from benign cutaneous eruptions to severe cutaneous adverse reactions. Sulfonamide antibiotics have retained importance as treatment for multiple indications and are especially relevant in immunocompromised patients wherein use is indicated for prevention of opportunistic infections. Sulfonamide antibiotic allergy labels may lead to inappropriate avoidance of other "sulfur"-containing medications, because cross-reactivity is unlikely between antibiotic and nonantimicrobial sulfonamides. In this review, we discuss the typical presentation of sulfonamide antibiotic hypersensitivity reactions. We also review risk stratification tools and current in vivo procedures and experimental in vitro evaluation methods. Lastly, we will provide an update on emerging pharmacogenomics data associated with sulfonamide medication adverse reactions.