Sulfonamide cross-reactivity: fact or fiction?
OBJECTIVE
To provide a critical and comprehensive review of the literature, specifically case reports and observational studies used to support the concept of cross-reactivity between sulfonylarylamines and non-sulfonylarylamines.


METHODS
A list of medications was formulated from several different review articles. A MEDLINE/PubMed search was conducted (1966-March 2004) using the individual medications and the MeSH terms of drug hypersensitivity/etiology, sulfonamides/adverse effects, and/or cross-reaction.


METHODS
A critical review of the methodology and conclusions for each article found in the search was conducted. The manufacturer's package insert (MPI) for each drug was examined for a statement concerning possible cross-reactivity in patients with a sulfonamide allergy. If indicated, the manufacturers were contacted to obtain any clinical data supporting the statement.


RESULTS
A total of 33 medications were identified. Seventeen (51.5%) of the MPIs contained statements of varying degrees concerning use in patients with a "sulfonamide" allergy; 21 case series, case reports, and other articles were found.


CONCLUSIONS
After a thorough critique of the literature, it appears that the dogma of sulfonylarylamine cross-reactivity with non-sulfonylarylamines is not supported by the data. While many of the case reports on the surface support the concept of cross-reactivity, on closer examination the level of evidence in many of the cases does not conclusively support either a connection or an association between the observed cause and effect.
Johnson
Kelly K
KK
Adult Internal Medicine Pharmacy Resident, Department of Pharmacy Services, Virginia Commonwealth University Medical Center-Medical College of Virginia (MCV) Campus, Richmond, VA 23298-0042, USA.
Green
David L
DL
Rife
Jason P
JP
Limon
Lynn
L
D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000737:chemistry; D004232:Diuretics / Q000009:adverse effects / Q000737:chemistry; D004342:Drug Hypersensitivity / Q000209:etiology; D004347:Drug Interactions; D004348:Drug Labeling; D006801:Humans; D013449:Sulfonamides / Q000009:adverse effects / Q000737:chemistry*
D016861:Cyclooxygenase Inhibitors; D004232:Diuretics; D013449:Sulfonamides