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Safety of Celecoxib in Individuals Allergic to Sulfonamide

A Pilot Study

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Abstract

Objective: To evaluate cross reactivity between sulfonamide antimicrobials and celecoxib in patients with histories of allergies to sulfonamide antimicrobials.

Methods: Immunocompetent patients with a history of sulfonamide antimicrobial allergy who were being considered for therapy with celecoxib were prospectively enrolled. Sulfamethoxazole and trimethoprim skin prick and intradermal testing and/or an in vitro lymphocyte toxicity assay were performed. If skin testing was negative, an oral challenge with sulfamethoxazole and trimethoprim was performed. Oral challenges with celecoxib were administered to all patients.

Results: Twenty-eight immunocompetent patients (26 female; mean age 60 years) were evaluated. History of sulfonamide antimicrobial allergy included urticaria (n = 7), cutaneous eruptions (n = 9), and other (n = 12). Four of the 28 patients who were skin prick tested were positive to sulfamethoxazole and two of the ten patients who underwent in vitro testing were positive to sulfamethoxazole. All 28 patients were administered celecoxib and tolerated the medication. Phone call follow up in 25 patients disclosed that 15 patients continued to take celecoxib, while five patients did not take celecoxib following the oral challenge, and five discontinued celecoxib due to adverse effects, lack of drug efficacy or physician preference.

Conclusions: Confusion exists regarding the potential for cross reactivity between sulfonamide antimicrobials and other sulfonamide-containing compounds. The six sulfonamide-allergic patients tolerated celecoxib uneventfully. This pilot study supports the hypothesis that the potential for cross-reactivity between celecoxib and sulfonamide antimicrobials appears to be low. However, further investigations are required to confirm this.

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References

  1. Hawkey CJ. Cox-2 inhibitors. Lancet 1999; 353: 307–14

    Article  PubMed  CAS  Google Scholar 

  2. Koch WJ, Sidel VW, Dexter M, et al. Adverse reactions to sulfisoxazole, sulfamethoxazole and nitrofurantoin: manifestations and specific reaction rates during 2118 courses of therapy. Arch Intern Med 1971; 128: 399–404

    Article  Google Scholar 

  3. Sullivan TJ. Cross-reactions among furosemide, hydrochlorothiazide and sulfonamides. JAMA 1991; 265: 120–1

    Article  PubMed  CAS  Google Scholar 

  4. Knowles S, Shapiro L, Shear NH. Should celecoxib be contraindicated in patients who are allergic to sulfonamides? Revisiting the meaning of ‘sulfa’ allergy. Drug Saf 2001; 24(4): 239–47

    Article  PubMed  CAS  Google Scholar 

  5. Hansbrough JR, Wedner HJ, Chaplin DD. Anaphylaxis to intravenous furosemide. J Allergy Clin Immunol 1987; 80: 538–41

    Article  PubMed  CAS  Google Scholar 

  6. Sullivan TJ. Cross-reactions among furosemide, hydrochlorothiazide and sulfonamides. JAMA 1991; 265: 120–1

    Article  PubMed  CAS  Google Scholar 

  7. Barrio M, Tornero P, Baeza M, et al. Cross-reactivity among the para-amine group in sulfonamide-induced urticaria and fixed drug eruption [abstract]. J Allergy Clin Immunol 1991; 87: 364A

    Article  Google Scholar 

  8. Stock JG. Sulfonamide hypersensitivity and acetazolamide. Arch Ophthalmol 1990; 108: 634–5

    Article  PubMed  CAS  Google Scholar 

  9. Schnewweiss F. Cross-sensitivity between sulfonamides and furosemide [letter]. Clin Pharm 1983; 2: 510

    Google Scholar 

  10. Stock JG. Sulfonamide hypersensitivity and acetazolamide. Arch Ophthalmol 1990; 108: 634–5

    Article  PubMed  CAS  Google Scholar 

  11. Stricker B, Biriell C. Skin reactions and fever with indapamide. BMJ 1987; 295: 1313–4

    Article  PubMed  CAS  Google Scholar 

  12. De Barrio M, Tornero P, Zubeldia JM, et al. Fixed drug eruption induced by indapamide: cross-reactivity with sulfonamides. J Investig Allergol Clin Immunol 1998; 8: 253–5

    PubMed  Google Scholar 

  13. Shenfield GM, Jacka J. Adverse drug reaction [letter]. Lancet 2001; 57: 561

    Article  Google Scholar 

  14. Bretza J. Thrombocytopenia due to sulfonamide cross-sensitivity. Wis Med J 1982; 81: 21–3

    PubMed  CAS  Google Scholar 

  15. Shenfield GM, Jacka J. Adverse drug reactions [letter]. Lancet 2001; 357: 561

    Article  PubMed  CAS  Google Scholar 

  16. Britschgi M, Steiner U, Schmid S, et al. T-cell involvement in drug-induced acute generalized exanthematous pustulosis. J Clin Invest 2001; 107: 1433–41

    Article  PubMed  CAS  Google Scholar 

  17. Neuman MG, Malkiewicz IM, Shear NH. A novel lymphocyte toxicity assay to assess drug hypersensitivity syndromes. Clin Biochem 2000 Oct; 33(7): 517–24

    Article  PubMed  CAS  Google Scholar 

  18. Weber EA, Uetrecht JP, Knowles SR, et al. Detection of sulfamethoxazole hypersensitivity: skin testing with sulfamethoxazoyl-poly-L-tyrosine [abstract]. J Allergy Clin Immunol 1994; 93: 623A

    Google Scholar 

  19. Gruchalla R, Sullivan T. Detection of human IgE to sulfamethoxazole by skin testing with sulfamethoxazoly-poly-L-tyrosine. J Allergy Clin Immunol 1991; 88: 784–92

    Article  PubMed  CAS  Google Scholar 

  20. Spielberg SP. Acetaminophen toxicity in human lymphocytes in vitro. J Pharmacol Exp Ther 1980; 213: 395–8

    PubMed  CAS  Google Scholar 

  21. Harle DG, Baldo BA, Wells JV. Drugs as allergens: detection and combining site specificities of IgE antibodies to sulfamethoxazole. Mol Immunol 1988; 25: 1347–54

    Article  PubMed  CAS  Google Scholar 

  22. Shear NH, Spielberg SP. Anticonvulsant hypersensitivity syndrome: in vitro assessment of risk. J Clin Invest 1988; 82: 1826–32

    Article  PubMed  CAS  Google Scholar 

  23. Knowles SR, Shapiro L, Shear NH. Serious adverse drug reactions induced by minocycline: report of 13 patients and review of the literature. Arch Dermatol 1996; 132: 934–9

    Article  PubMed  CAS  Google Scholar 

  24. Rieder M, Uetrecht J, Shear NH, et al. Diagnosis of sulfonamide hypersensitivity reactions by in-vitro ‘rechallenge’ with hydroxylamine metabolites. Ann Intern Med 1989; 110: 286–9

    PubMed  CAS  Google Scholar 

  25. Rieder M, Ueterecht J, Shear NH, et al. Diagnosis of sulfonamide hypersensitivity reactions by in vitro ‘rechallenge’ with hydroxylamine metabolites. Ann Intern Med 1989; 110: 286–9

    PubMed  CAS  Google Scholar 

  26. Cribb A, Spielberg S. Hepatic microsomal metabolism of sulfamethoxazole to the hydroxylamine. Drug Metab Dispos 1990; 18: 784–7

    PubMed  CAS  Google Scholar 

  27. Cribb A, Spielberg S, Griffin G. N4-hydroxylation of sulfamethoxazole by cytochrome P450 of the cytochrome P4502C subfamily and reduction of sulfamethoxazole hydroxylamine in human and rat hepatic microsomes. Drug Metab Dispos 1995; 23: 406–14

    PubMed  CAS  Google Scholar 

  28. Cribb A, Miller M, Leeder J, et al. Reactions of the nitroso and hydroxylamine metabolites of sulfamethoxazole with reduced glutathione. Drug Metab Dispos 1991; 19: 900–6

    PubMed  CAS  Google Scholar 

  29. Spielberg SP, Leeder JS, Cribb AE, et al. Is sulfamethoxazole hydroxylamine the proximal toxin for sulfamethoxazole toxicity? Eur J Clin Pharmacol 1989; A173: 04:37

    Google Scholar 

  30. Rieder MJ, Uetrecht J, Shear NH, et al. Diagnosis of sulfonamide hypersensitivity reactions by in-vitro ‘rechallenge’ with hydroxylamine metabolites. Ann Intern Med 1989; 110(4): 286–9

    PubMed  CAS  Google Scholar 

  31. Naisbitt DJ, Hough SJ, Gill HJ, et al. Cellular disposition of sulfamethoxazole and its metabolites: implications for hypersensitivity. Br J Pharmacol 1999 Mar; 12: 1393–407

    Article  Google Scholar 

  32. Cribb AE, Lee BL, Trepanier LA, et al. Adverse reactions to sulfonamide and sulfonamide-trimethoprim antimicrobials: clinical syndromes and pathogenesis. Adverse Drug React Toxicol Rev 1996 Mar; 1: 9–50

    Google Scholar 

  33. Shapiro LE, Neuman MG, Malkiewicz I, et al. Assessment of sulfonamide-induced hypersensitivity syndrome reactions with the use of a novel lymphocyte toxicity assay: preliminary results. Clin Invest Med 1998; 21:Suppl. 15: A571

    Google Scholar 

  34. Neuman MG, Shapiro LE, Phillips E, et al. Lymphocyte toxicity test as a predictor of hypersensitivity reactions in immunocompetent and immunocompromised populations [abstract]. Ther Drug Monit 1999; 21: 453

    Article  Google Scholar 

  35. Neuman MG, Malkiewicz IM, Shear NH. A novel lymphocyte toxicity assay to assess drug hypersensitivity syndromes. Clin Biochem 2000 Oct; 33(7): 517–24

    Article  PubMed  CAS  Google Scholar 

  36. Newman LC, Lay CL, O’Connor KA, et al. Lack of cross-reactivity to sumatriptan in patients allergic to sulfonamides: a retrospective chart review [letter]. Headache 1999; 39: 372

    Google Scholar 

  37. Patterson R, Bello AE, Lefkowith J. Immunologic tolerability profile of celecoxib. Clin Ther 1999 Dec; 21: 2065–79

    Article  PubMed  CAS  Google Scholar 

  38. Wilholm BE. Identification of sulfonamide-like adverse drug reactions to celecoxib in the World Health Organizaion database. Curr Med Res Opin 2001; 17: 210–6

    Google Scholar 

  39. Weber EA, Knight A. Testing for allergy to antibiotics. Semin Dermatol 1989; 8: 204–12

    PubMed  CAS  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. Dr S. Knowles and Dr N. Shear have acted as paid consultants for Pharmacia and Pfizer.

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Authors and Affiliations

  1. Division of Clinical Pharmacology, Drug Safety Research Group, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Room E-240; 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada

    Lori E. Shapiro & Neil H. Shear

  2. Division of Dermatology, Drug Safety Research Group, University of Toronto, Toronto, Ontario, Canada

    Lori E. Shapiro & Neil H. Shear

  3. Division of Drug Safety Clinic, Drug Safety Research Group, University of Toronto, Toronto, Ontario, Canada

    Lori E. Shapiro, Sandra R. Knowles, Elizabeth Weber & Neil H. Shear

  4. Department of Medicine, Drug Safety Research Group, University of Toronto, Toronto, Ontario, Canada

    Lori E. Shapiro, Sandra R. Knowles & Neil H. Shear

  5. Department of Pharmacology, Drug Safety Research Group, University of Toronto, Toronto, Ontario, Canada

    Manuela G. Neuman & Neil H. Shear

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  1. Lori E. Shapiro
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  2. Sandra R. Knowles
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  3. Elizabeth Weber
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  4. Manuela G. Neuman
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  5. Neil H. Shear
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Correspondence to Lori E. Shapiro.

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Shapiro, L.E., Knowles, S.R., Weber, E. et al. Safety of Celecoxib in Individuals Allergic to Sulfonamide. Drug-Safety 26, 187–195 (2003). https://doi.org/10.2165/00002018-200326030-00004

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  • DOI: https://doi.org/10.2165/00002018-200326030-00004

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