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Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?
Am J Ophthalmol. 2004 Jul; 138(1):114-8.AJ

Abstract

PURPOSE

To determine whether acetazolamide or furosemide produce allergic cross-reactions in patients with self-reported "sulfa allergy."

DESIGN

Retrospective case series.

METHODS

A retrospective review included patients with intracranial hypertension and a self-reported sulfa allergy treated with either acetazolamide or furosemide seen at the University of Iowa Hospitals and Clinics from 1972 to 2003. All presumed medication-related side effects were collected, including both predictable adverse effects (for example, paresthesias, fatigue) and unpredictable adverse reactions (for example, cutaneous fixed eruptions, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, anaphylaxis).

RESULTS

We reviewed 363 charts. Of these, 329 patients (91%) were excluded. Of the remaining 34 cases that did report a so-called sulfa allergy, 13 (38%) received acetazolamide alone, 7 (21%) received furosemide alone, and 14 (41%) received both acetazolamide and furosemide. Of the 27 patients who received acetazolamide, 10 (37%) had no documented allergic cross-reaction to sulfa, and 2 (7%) cases had urticaria. The remaining 15 (56%) of acetazolamide-treated patients experienced predictable adverse reactions for this drug (for example, paresthesias). No patient experienced a severe allergic cross-reaction to sulfa. Of 21 patients who received furosemide, no unpredictable adverse reactions or allergic cross-reactions to sulfa were noted.

CONCLUSIONS

We find little clinical or pharmacological evidence to suggest that a self-reported sulfa allergy is likely to produce a life-threatening cross-reaction with acetazolamide or furosemide. These medications should be considered for intracranial hypertension if the risk-to-benefit ratio warrants their use.

Authors+Show Affiliations

Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. andrew-lee@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15234289

Citation

Lee, Andrew G., et al. "Presumed "sulfa Allergy" in Patients With Intracranial Hypertension Treated With Acetazolamide or Furosemide: Cross-reactivity, Myth or Reality?" American Journal of Ophthalmology, vol. 138, no. 1, 2004, pp. 114-8.
Lee AG, Anderson R, Kardon RH, et al. Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? Am J Ophthalmol. 2004;138(1):114-8.
Lee, A. G., Anderson, R., Kardon, R. H., & Wall, M. (2004). Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? American Journal of Ophthalmology, 138(1), 114-8.
Lee AG, et al. Presumed "sulfa Allergy" in Patients With Intracranial Hypertension Treated With Acetazolamide or Furosemide: Cross-reactivity, Myth or Reality. Am J Ophthalmol. 2004;138(1):114-8. PubMed PMID: 15234289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? AU - Lee,Andrew G, AU - Anderson,Randy, AU - Kardon,Randy H, AU - Wall,Michael, PY - 2003/12/10/received PY - 2004/02/09/accepted PY - 2004/7/6/pubmed PY - 2004/9/1/medline PY - 2004/7/6/entrez SP - 114 EP - 8 JF - American journal of ophthalmology JO - Am. J. Ophthalmol. VL - 138 IS - 1 N2 - PURPOSE: To determine whether acetazolamide or furosemide produce allergic cross-reactions in patients with self-reported "sulfa allergy." DESIGN: Retrospective case series. METHODS: A retrospective review included patients with intracranial hypertension and a self-reported sulfa allergy treated with either acetazolamide or furosemide seen at the University of Iowa Hospitals and Clinics from 1972 to 2003. All presumed medication-related side effects were collected, including both predictable adverse effects (for example, paresthesias, fatigue) and unpredictable adverse reactions (for example, cutaneous fixed eruptions, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, anaphylaxis). RESULTS: We reviewed 363 charts. Of these, 329 patients (91%) were excluded. Of the remaining 34 cases that did report a so-called sulfa allergy, 13 (38%) received acetazolamide alone, 7 (21%) received furosemide alone, and 14 (41%) received both acetazolamide and furosemide. Of the 27 patients who received acetazolamide, 10 (37%) had no documented allergic cross-reaction to sulfa, and 2 (7%) cases had urticaria. The remaining 15 (56%) of acetazolamide-treated patients experienced predictable adverse reactions for this drug (for example, paresthesias). No patient experienced a severe allergic cross-reaction to sulfa. Of 21 patients who received furosemide, no unpredictable adverse reactions or allergic cross-reactions to sulfa were noted. CONCLUSIONS: We find little clinical or pharmacological evidence to suggest that a self-reported sulfa allergy is likely to produce a life-threatening cross-reaction with acetazolamide or furosemide. These medications should be considered for intracranial hypertension if the risk-to-benefit ratio warrants their use. SN - 0002-9394 UR - https://www.unboundmedicine.com/medline/citation/15234289/Presumed_"sulfa_allergy"_in_patients_with_intracranial_hypertension_treated_with_acetazolamide_or_furosemide:_cross_reactivity_myth_or_reality L2 - https://linkinghub.elsevier.com/retrieve/pii/S000293940400145X DB - PRIME DP - Unbound Medicine ER -