Current Allergy and Asthma Reports

, Volume 2, Issue 1, pp 16–25

Allergic adverse reactions to sulfonamides

  • Geneviève Choquet-Kastylevsky
  • Thierry Vial
  • Jacques Descotes
Article

DOI: 10.1007/s11882-002-0033-y

Cite this article as:
Choquet-Kastylevsky, G., Vial, T. & Descotes, J. Curr Allergy Asthma Rep (2002) 2: 16. doi:10.1007/s11882-002-0033-y

Abstract

Antimicrobial sulfonamides were the first antimicrobial agents used effectively to treat infectious diseases. However, because they may cause severe adverse drug reactions (ADRs) and because more effective agents have since been developed, sulfonamides now are used for only a few indications in specific groups, such as AIDS patients. Skin reactions, from benign rash to potentially lethal toxidermias, are the most frequent ADRs to sulfonamides. Other major ADRs include acute liver injury, pulmonary reactions, and blood dyscrasias. Although the mechanisms involved have not been fully elucidated, reactive metabolites appear to play a pivotal role. The hydroxylamine and nitroso metabolites of sulfamethoxazole, the most frequently used sulfonamide today, can bind covalently to proteins because of their chemical reactivity, resulting in the induction of specific adverse immune responses. Therefore, changes in the activity of metabolic and detoxification pathways are associated with a greater risk for developing allergic reactions to sulfonamides. Allergies to sulfonamides, particularly sulfamethoxazole (often used in combination with trimethoprim as co-trimoxazole), are more frequent in AIDS patients, but the reason for this increased risk is not fully understood. No valid tools are available to predict which patients have a greater risk for developing allergies to sulfonamides. Diagnosis is essential to avoid a possible evolution toward severe reactions and readministration of the offending drug. In patients who absolutely require further treatment, successful desensitization may be achieved.

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Geneviève Choquet-Kastylevsky
    • 1
  • Thierry Vial
    • 1
  • Jacques Descotes
    • 1
  1. 1.BioMérieux, Chemin de l’OrmeMarcy l’EtoileFrance