Sulfa

Allergy
Introduction
Sulfonamide medications are drugs that contain a sulfonamide moiety (SO2NH2)

“Sulfa Drugs” often applied to sulfonamide antimicrobials , although it is variably used for
nonantimicrobial sulfonamides as well.

Sulfa allergy terms to adverse reactions and symptoms caused by antimicrobial Sulfonamide
medications.
Sulfonamides are divided into two distinct groups :
1. Antimicrobials
2. Non antimicrobials
Sulfanamide Antimicrobials
First antibiotics to be used systemically
They are Dihydropteroate synthase inhibitors that have bacteriostatic action
Most commonly used Sulfonamide is Co-trimoxazole, a combination of sulfamethoxazole and
Trimethoprim
Use has decreased because of resistance and adverse reactions
#Nonantimicrobial Sulfonamides do not cause the adverse
reactions as seen in antimicrobials and there is minimal
evidence of cross reactivity.
Variation
Anti-microbial Sulfonamides share two essential functional groups :

An Arylamine at N4

An aromatic heterocyclic ring at N1

The presence of both moieties is essential to their antimicrobial action and is also believed to be
central to the pathogenesis of hypersensitive reactions.

The non antimicrobial sulfonamides do not contain an arylamine group or a substituted

aromatic heterocyclic ring.
Mechanism of Action
Pathophysiology
Sulfonamide antibiotic allergy is multifactorial :

Metabolism of sulfonamide antimicrobials to reactive metabolites that act as Haptens and link with
protein complexes to initiate an immunologic reaction.

Some immediate metabolites can be directly cytotoxic

Interaction between T-cell receptors and unmetabolized antimicrobials

Case Summary
An 82-year-old woman with a history of hypersensitivity reactions to sulfamethoxazole-trimethoprim
resulting in angioedema and rash presented to the emergency department (ED) with angioedema and
severe dysphagia, shortness of breath, and rash after receiving valsartan and hydrochlorothiazide
(HCTZ) for 4 months. Valsartan was identified as the most likely cause of the symptoms and was
discontinued; however, the patient continued to have weekly episodes of angioedema and eventually
returned to the ED. HCTZ was discontinued at the second ED visit, and the angioedema disappeared.
However, it reappeared after reinitiation of HCTZ, and the patient returned to the ED again; this time
with more severe symptoms. After the third ED visit and second hospitalization, HCTZ was
permanently discontinued, and the angioedema has not returned. HCTZ was the definite cause of
angioedema in this patient based on a score of 9 on the 10-point Naranjo adverse drug reaction
probability scale.
Case conclusion
Although the probability of true cross-reactivity is not known, clinicians should be aware that an
allergic-like reaction to sulfonamide-containing nonantibiotics may occur in patients with known
allergies to sulfonamide-containing antibiotics. These patients should be monitored closely when
receiving these drugs. Further evaluation is needed to determine whether angioedema should be added
to the list of adverse events associated with HCTZ.
 Sulfa allergy symptoms
If the patient is allergic to sulfa drugs, he or she can show signs ;

Isolated cutaneous reactions

Moniliform rash with fever and systemic symptoms

Itchy eyes or skin

Breathing problems

Face swelling

The reaction can also cause skin reactions such as :

Sulphonamide drug hypersensitivity syndrome:  Rash, fever, and organ problems begin a week or two after you start the
drug.

Drug eruption: Red or swollen, rounded patches form in 30 minutes to 8 hours.

Stevens-Johnson syndrome This potentially life-threatening reaction causes the skin to blister and peel off And Toxic
epidermal necrolysis

Other reactions to sulfa drugs include headache, trouble sleeping, cloudy urine  (crystalluria), and low blood counts. Rarely, a
severe allergic reaction called anaphylaxis happens.
Sulfa Allergy Treatments

1. Antihistamines
2. Corticosteroids
3. Epinephrine ( for anaphylaxis )
If the patient is allergic to a medication that he or she need to take, the doctor
could start it slowly. This is called drug desensitization. You’ll take a very small
dose at first and then larger doses over several hours or days. The doctor will
watch the patient closely for any negative reactions.