- second most common drug allergy (second to penicillin)
- sulfonamide moity = SO2NH2
- antimicrobials: arylamine + aromatic ring on sulfa core = forms analog of para-aminobenzoic acid --> essential for antimicrobial action but also contributes to hypersensitvity reactions
- nonantimicrobial agents -- do not contain arylamine: diuretics (furosemide, HCTZ, acetazolamide), hypoglycemics (glyburide), anti-inflammatories (celecoxib, sulfasalazine), anti-hypertensives, sumatriptan
- sulfone: dapsone, not a sulfonamide but hypersensitivity reaction is clinically similar
- HIV increases susceptibility to sulfonamide reactions
- most commonly presents as fever and mobilliform rash
- develops within 1-2 weeks of initiation of therapy
- can be mild but also can progress to organ failure
- generally avoid drugs in the class, however, if clinically necessary, patients can undergo desensitization
- generally takes 1-2 for symptoms to resolve
- if re-exposed, symptoms may develop more rapidly within 1-2 days
- antibiotics are associated with Stevens-Johnson Syndrome and toxic epidermal necrolysis
- patients must STRICTLY AVOID
- re-exposure may be fatal
- non-antibiotics are not associated with SJS/TEN
- minimal evidence of cross-reactivity between antibiotic and non-antibiotic sulfonamides
- predisposition to drug hypersensitivity reactions in general is more predictive
- need to assess what type of reaction patient had (distinguish between fever/rash vs SJS/TEN)
- if need to desensitize (administer small and increasing doses under careful medical supervision), usually for patients who have type 1 IgE mediated reactions
Reference:
Montanaro A. Sulfonamide allergy in HIV-uninfected patients. UpToDate. Adkinson NF (Ed). Accessed on: November 16 2016.
No comments:
Post a Comment