Sulfa Antibiotics and Sulfa drugs...the myth of cross reaction

There is minimal evidence of cross-reactivity between sulfonamide antibiotics and non-antibiotics . Despite this, the U.S. FDA-approved product information for many non-antibiotic sulfonamide drugs contains warnings concerning possible cross-reactions.

Key Findings from a New Review Article [1]:

An estimated 3-6% of the general population is allergic to sulfonamides.
Structurally, none of the non-antibiotic sulfonamides exhibit both of the features shown to be responsible for sulfonamide reactions (i.e., an N-containing ring attached to the N1 nitrogen of the sulfonamide group and an arylamine group at the N4 position).
A comprehensive literature search (1966-December 2011) identified only 9 case reports indicating possible cross-reactivity to sulfonamide medications; however, in most cases, adequate patient testing was not conducted to firmly establish either sulfa allergy or sulfonamide cross-sensitivity.

Take home msg: You can feel safe prescribing furosemide, glyburide, and hydrochlorothiazide to your patient with an allergy to sulfamethoxazole/trimethoprim.

1-Wulf NR, et al. Sulfonamide cross-reactivity: Is there evidence to support broad cross-allergenicity? Am J Health-Syst Pharm 2013;70(17):1483-94

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