Sulfonamide Hypersensitivity

Sulfonamides, particularly antimicrobial sulfonamides, have been implicated as a common cause of a spectrum of hypersensitivity reactions. Immediate IgE-mediated reactions have been reported but are much less common than delayed cutaneous reactions. Delayed cutaneous reactions range from benign exan...

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Bibliographic Details
Published in:Clinical reviews in allergy & immunology 2022-06, Vol.62 (3), p.400-412
Main Authors: Chow, Timothy G, Khan, David A
Format: Article
Language:English
Subjects:
Allergic reaction
Allergology
Allergy
Antibiotics
Antimicrobial agents
Complications and side effects
Cross-reactivity
Cytochrome
Eosinophilia
HIV
HIV infection
Human immunodeficiency virus
Hydrochlorothiazide
Hypersensitivity (immediate)
Ibutilide
Immune system
Immunoglobulin E
Immunology
Internal Medicine
Medicine
Medicine & Public Health
Metabolism
Metabolites
Oxidative stress
Skin
Skin tests
Sulfonamides
Sulfur
T cell receptors
Toxic epidermal necrolysis
Virus diseases
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Summary:Sulfonamides, particularly antimicrobial sulfonamides, have been implicated as a common cause of a spectrum of hypersensitivity reactions. Immediate IgE-mediated reactions have been reported but are much less common than delayed cutaneous reactions. Delayed cutaneous reactions range from benign exanthems to severe cutaneous reactions such as Stevens Johnson syndrome, toxic epidermal necrolysis, or drug reaction with eosinophilia and systemic symptoms. Sulfonamides can be subclassified as antimicrobial sulfonamides and non-antimicrobial sulfonamides, which are also distinguished by key structural differences, resulting in very low risk of cross-reactivity between these two subclasses. Immediate and delayed skin testing and in vitro testing remain limited as options in evaluating antimicrobial sulfonamide hypersensitivity. Drug challenges continue to play an important role in the evaluation of both immediate and delayed reactions, with a growing body of evidence for the safety of direct challenges regardless of human immunodeficiency virus infection status. While numerous “desensitization” protocols have been described for the management of antimicrobial sulfonamide hypersensitivity, there is limited evidence that such procedures are successful because of an induction of tolerance.
ISSN:1559-0267
1080-0549
1559-0267
DOI:10.1007/s12016-021-08872-3