Drug Safety

, Volume 26, Issue 3, pp 187–195 | Cite as

Safety of Celecoxib in Individuals Allergic to Sulfonamide

A Pilot Study
  • Lori E. Shapiro
  • Sandra R. Knowles
  • Elizabeth Weber
  • Manuela G. Neuman
  • Neil H. Shear
Original Research Article

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.

References

  1. 1.
    Hawkey CJ. Cox-2 inhibitors. Lancet 1999; 353: 307–14PubMedCrossRefGoogle Scholar
  2. 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: 399–404CrossRefGoogle Scholar
  3. 3.
    Sullivan TJ. Cross-reactions among furosemide, hydrochlorothiazide and sulfonamides. JAMA 1991; 265: 120–1PubMedCrossRefGoogle Scholar
  4. 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): 239–47PubMedCrossRefGoogle Scholar
  5. 5.
    Hansbrough JR, Wedner HJ, Chaplin DD. Anaphylaxis to intravenous furosemide. J Allergy Clin Immunol 1987; 80: 538–41PubMedCrossRefGoogle Scholar
  6. 6.
    Sullivan TJ. Cross-reactions among furosemide, hydrochlorothiazide and sulfonamides. JAMA 1991; 265: 120–1PubMedCrossRefGoogle Scholar
  7. 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: 364ACrossRefGoogle Scholar
  8. 8.
    Stock JG. Sulfonamide hypersensitivity and acetazolamide. Arch Ophthalmol 1990; 108: 634–5PubMedCrossRefGoogle Scholar
  9. 9.
    Schnewweiss F. Cross-sensitivity between sulfonamides and furosemide [letter]. Clin Pharm 1983; 2: 510Google Scholar
  10. 10.
    Stock JG. Sulfonamide hypersensitivity and acetazolamide. Arch Ophthalmol 1990; 108: 634–5PubMedCrossRefGoogle Scholar
  11. 11.
    Stricker B, Biriell C. Skin reactions and fever with indapamide. BMJ 1987; 295: 1313–4PubMedCrossRefGoogle Scholar
  12. 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: 253–5PubMedGoogle Scholar
  13. 13.
    Shenfield GM, Jacka J. Adverse drug reaction [letter]. Lancet 2001; 57: 561CrossRefGoogle Scholar
  14. 14.
    Bretza J. Thrombocytopenia due to sulfonamide cross-sensitivity. Wis Med J 1982; 81: 21–3PubMedGoogle Scholar
  15. 15.
    Shenfield GM, Jacka J. Adverse drug reactions [letter]. Lancet 2001; 357: 561PubMedCrossRefGoogle Scholar
  16. 16.
    Britschgi M, Steiner U, Schmid S, et al. T-cell involvement in drug-induced acute generalized exanthematous pustulosis. J Clin Invest 2001; 107: 1433–41PubMedCrossRefGoogle Scholar
  17. 17.
    Neuman MG, Malkiewicz IM, Shear NH. A novel lymphocyte toxicity assay to assess drug hypersensitivity syndromes. Clin Biochem 2000 Oct; 33(7): 517–24PubMedCrossRefGoogle Scholar
  18. 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: 623AGoogle Scholar
  19. 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: 784–92PubMedCrossRefGoogle Scholar
  20. 20.
    Spielberg SP. Acetaminophen toxicity in human lymphocytes in vitro. J Pharmacol Exp Ther 1980; 213: 395–8PubMedGoogle Scholar
  21. 21.
    Harle DG, Baldo BA, Wells JV. Drugs as allergens: detection and combining site specificities of IgE antibodies to sulfamethoxazole. Mol Immunol 1988; 25: 1347–54PubMedCrossRefGoogle Scholar
  22. 22.
    Shear NH, Spielberg SP. Anticonvulsant hypersensitivity syndrome: in vitro assessment of risk. J Clin Invest 1988; 82: 1826–32PubMedCrossRefGoogle Scholar
  23. 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: 934–9PubMedCrossRefGoogle Scholar
  24. 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: 286–9PubMedGoogle Scholar
  25. 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: 286–9PubMedGoogle Scholar
  26. 26.
    Cribb A, Spielberg S. Hepatic microsomal metabolism of sulfamethoxazole to the hydroxylamine. Drug Metab Dispos 1990; 18: 784–7PubMedGoogle Scholar
  27. 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: 406–14PubMedGoogle Scholar
  28. 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: 900–6PubMedGoogle Scholar
  29. 29.
    Spielberg SP, Leeder JS, Cribb AE, et al. Is sulfamethoxazole hydroxylamine the proximal toxin for sulfamethoxazole toxicity? Eur J Clin Pharmacol 1989; A173: 04:37Google Scholar
  30. 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): 286–9PubMedGoogle Scholar
  31. 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: 1393–407CrossRefGoogle Scholar
  32. 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: 9–50Google Scholar
  33. 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: A571Google Scholar
  34. 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: 453CrossRefGoogle Scholar
  35. 35.
    Neuman MG, Malkiewicz IM, Shear NH. A novel lymphocyte toxicity assay to assess drug hypersensitivity syndromes. Clin Biochem 2000 Oct; 33(7): 517–24PubMedCrossRefGoogle Scholar
  36. 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: 372Google Scholar
  37. 37.
    Patterson R, Bello AE, Lefkowith J. Immunologic tolerability profile of celecoxib. Clin Ther 1999 Dec; 21: 2065–79PubMedCrossRefGoogle Scholar
  38. 38.
    Wilholm BE. Identification of sulfonamide-like adverse drug reactions to celecoxib in the World Health Organizaion database. Curr Med Res Opin 2001; 17: 210–6Google Scholar
  39. 39.
    Weber EA, Knight A. Testing for allergy to antibiotics. Semin Dermatol 1989; 8: 204–12PubMedGoogle Scholar

Copyright information

© Adis International Limited 2003

Authors and Affiliations

  • Lori E. Shapiro
    • 1
    • 2
    • 3
    • 4
  • Sandra R. Knowles
    • 3
    • 4
  • Elizabeth Weber
    • 3
  • Manuela G. Neuman
    • 5
  • Neil H. Shear
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.Division of Clinical Pharmacology, Drug Safety Research Group, Sunnybrook and Women’s College Health Sciences CentreUniversity of TorontoTorontoCanada
  2. 2.Division of Dermatology, Drug Safety Research GroupUniversity of TorontoTorontoCanada
  3. 3.Division of Drug Safety Clinic, Drug Safety Research GroupUniversity of TorontoTorontoCanada
  4. 4.Department of Medicine, Drug Safety Research GroupUniversity of TorontoTorontoCanada
  5. 5.Department of Pharmacology, Drug Safety Research GroupUniversity of TorontoTorontoCanada

Personalised recommendations