Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.
Division of Clinical Pharmacology and Toxicology, Department of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
J Allergy Clin Immunol Pract. 2019 Sep-Oct;7(7):2116-2123. doi: 10.1016/j.jaip.2019.05.034.
Sulfonamide antimicrobials are commonly reported as causing drug allergy and have been implicated in a variety of hypersensitivity reactions including immediate IgE-mediated reactions, benign T-cell-mediated rashes, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. Cross-reactivity is unlikely between sulfonamide antimicrobials and sulfonamide non-antimicrobials. In patients who develop reactions to a sulfonamide non-antimicrobial, there is no evidence to suggest that sulfonamide antimicrobials and other sulfonamide non-antimicrobials would cross-react. Although immediate skin testing can be performed in patients with histories of immediate reactions, they are infrequently positive and wane over time. Delayed skin testing including patch tests to sulfonamides is rarely positive. Drug challenges are a useful tool for patients with both immediate and delayed reactions to sulfonamides. The role of sulfamethoxazole desensitization is controversial as rates of hypersensitivity reactions are similar between desensitization and drug challenge.
磺胺类抗菌药物通常被报道为引起药物过敏，并与各种过敏反应有关，包括立即 IgE 介导的反应、良性 T 细胞介导的皮疹以及严重的皮肤不良反应，如史蒂文斯-约翰逊综合征、中毒性表皮坏死松解症和药物反应伴嗜酸性粒细胞增多和全身症状。磺胺类抗菌药物与磺胺类非抗菌药物之间不太可能发生交叉反应。在对磺胺类非抗菌药物产生反应的患者中，没有证据表明磺胺类抗菌药物和其他磺胺类非抗菌药物会发生交叉反应。尽管对于有立即反应史的患者可以进行即时皮肤测试，但它们通常呈阴性，并且随着时间的推移而减弱。磺胺类药物延迟皮肤测试（包括斑贴试验）很少呈阳性。药物挑战是对磺胺类药物有立即和延迟反应的患者的有用工具。磺胺甲恶唑脱敏的作用存在争议，因为脱敏和药物挑战之间的过敏反应发生率相似。
