First Databank, Inc., St. Louis, MO 63141, USA.
Am J Health Syst Pharm. 2013 Sep 1;70(17):1483-94. doi: 10.2146/ajhp120291.
Published and manufacturer-provided data regarding potential cross-reactivity between antibacterial and nonantibacterial sulfonamide agents are reviewed.
An estimated 3-6% of the general population is allergic to sulfonamides and thus at risk for type I and other hypersensitivity reactions to sulfamethoxazole and other sulfonamide antibacterial agents. Concerns have been raised that a history of sulfa allergy may be associated with an increased risk of adverse reactions to a wide range of nonantibacterial sulfonamides, including certain antivirals, carbonic anhydrase inhibitors, cyclooxygenase-2- selective nonsteroidal antiinflammatory drugs, loop and thiazide diuretics, and sulfonylureas; concerns have also been raised that patients who have experienced an allergic reaction to one nonantibacterial sulfonamide may be at risk for an adverse reaction to others. Structurally, none of the nonantibiotic 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), and only two agents (amprenavir and fosamprenavir) have the latter characteristic. A comprehensive literature search (1966-December 2011) identified nine 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. The weight of evidence suggests that withholding nonantibacterial sulfonamides from patients with prior reactions to antibacterial sulfonamides or other nonantibacterial sulfonamides is not clinically justified.
A review of the professional literature and manufacturer-provided data did not find convincing evidence of broad cross-reactivity between antibacterial and nonantibacterial sulfonamide agents.
综述了已发表的和制造商提供的数据，以了解抗菌和非抗菌磺胺类药物之间潜在的交叉反应。
估计有 3-6%的普通人群对磺胺类药物过敏，因此有发生磺胺甲恶唑和其他磺胺类抗菌药物的 I 型和其他过敏反应的风险。有人担心，磺胺类药物过敏史可能与广泛的非抗菌磺胺类药物（包括某些抗病毒药、碳酸酐酶抑制剂、环氧化酶-2 选择性非甾体抗炎药、环和噻嗪类利尿剂以及磺酰脲类药物）不良反应风险增加有关；也有人担心，对一种非抗菌磺胺类药物发生过敏反应的患者可能有发生其他非抗菌磺胺类药物不良反应的风险。从结构上看，没有一种非抗生素磺胺类药物同时具有被认为是磺胺类药物反应原因的两个特征（即，一个含氮环连接到磺胺基团的 N1 氮和 N4 位置的芳基胺基团），并且只有两种药物（氨普那韦和福沙那韦）具有后者的特征。全面的文献检索（1966 年至 2011 年 12 月）确定了九份表明可能对磺胺类药物交叉反应的病例报告；然而，在大多数情况下，没有进行充分的患者测试来确定磺胺类药物过敏或磺胺类药物交叉敏感性。现有证据表明，对于以前对抗菌磺胺类药物或其他非抗菌磺胺类药物有反应的患者，不应该拒绝使用非抗菌磺胺类药物。
对专业文献和制造商提供的数据的回顾并未发现抗菌和非抗菌磺胺类药物之间存在广泛交叉反应的令人信服的证据。
