Brackett Carolyn C
The Ohio State University, 500 West 12th Avenue, Columbus, OH 43210, USA.
Curr Allergy Asthma Rep. 2007 Apr;7(1):41-8. doi: 10.1007/s11882-007-0029-8.
Concerns about cross-allergenicity between sulfonamide antibiotics and nonantibiotic sulfonamide-containing drugs continue to complicate pharmacotherapy. Several elegant investigations have demonstrated unequivocal lack of interaction between the sulfonamide group and either cellular or humoral immunity. The immunologic determinant of type I immunologic responses to sulfonamide antibiotics is the N1 heterocyclic ring, and nonantibiotic sulfonamides lack this structural feature. Many non-type I hypersensitivity responses to sulfonamide antibiotics are attributable to reactive metabolites that cause either direct cytotoxicity or humoral or cellular responses. Metabolite formation is stereospecific to the N4 amino nitrogen of the sulfonamide antibiotics, a structure not found on any nonantibiotic sulfonamide drugs. Cellular immune responses to sulfonamide antibiotics are responsible for many non-immunoglobulin E-mediated dermatologic reactions; however, the stereospecificity of T-cell response renders cross-reactivity between sulfonamide antibiotics and nonantibiotics highly unlikely. Apparent cross-reactivity responses to sulfonamide-containing drugs likely represent multiple concurrent, rather than linked, drug hypersensitivities.
对磺胺类抗生素与含非抗生素磺胺类药物之间交叉变应原性的担忧继续使药物治疗变得复杂。多项精细的研究已明确证明磺胺类基团与细胞免疫或体液免疫之间不存在相互作用。对磺胺类抗生素I型免疫反应的免疫决定因素是N1杂环,而含非抗生素磺胺类药物缺乏这一结构特征。对磺胺类抗生素的许多非I型超敏反应归因于反应性代谢产物,这些代谢产物会引起直接细胞毒性或体液或细胞反应。代谢产物的形成对磺胺类抗生素的N4氨基氮具有立体特异性,而含非抗生素磺胺类药物上不存在这种结构。对磺胺类抗生素的细胞免疫反应是许多非免疫球蛋白E介导的皮肤反应的原因;然而,T细胞反应的立体特异性使得磺胺类抗生素与非抗生素之间发生交叉反应的可能性极小。对含磺胺类药物明显的交叉反应可能代表多种同时发生而非相关联的药物超敏反应。