Sulfa Sulfur Sulfate Sulfite: Which Causes An Allergy
Lauren R. Cirrincione, PharmD Kimberly K. Scarsi, PharmD
What constitutes a sulfa allergy?
|Response from Lauren R. Cirrincione, PharmD Postdoctoral Research Associate, Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, Nebraska|
|Response from Kimberly K. Scarsi, PharmD Associate Professor, Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, Nebraska|
A chart review of 2.4 million patients in California found that approximately 4% reported an allergy to sulfonamide antimicrobials. The term “sulfonamide antimicrobial” includes trimethoprim/sulfamethoxazole , sulfadiazine, and erythromycin/sulfisoxazole. Sulfonamide antimicrobials differ in chemical structure from nonantimicrobial sulfonamides, and those structural differences are implicated in hypersensitivity associated with sulfa antimicrobials.
Drug allergy, broadly called “hypersensitivity,” is an immune-mediated response against a medication. Hypersensitivity reactions may present either immediately or be delayed . Immediate hypersensitivity is generally immunoglobulin E -mediated urticaria, angioedema, rhinitis, bronchospasm, or anaphylaxis. Delayed hypersensitivity is T-cell dependent, presenting as either a maculopapular rash or more serious blistering and mucosal involvement, presaging Stevens-Johnson syndrome or toxic epidermal necrolysis.
The Truth About Drug Allergies
How to tell an allergy from a side effect, the big offenders, the types of medication reactions, and what to do if youre busting out in hives.
IT WAS a string of bad luck. First, Julie Sanes house was destroyed in a fire and her family was forced to quickly find a temporary place to live. Unfortunately the only place they could find was dusty and moldy, and her daughter Harper began getting sinus infections.
Harpers doctor prescribed amoxicillin to clear up the infection. But after the third dose, Sane noticed small, red raised bumps on Harpers arm, which spread to her tummy Harper also developed a sore in her nose. Harper had two more rounds of amoxicillin in the coming months and each time, on the third dose, the girl developed a rash and a sore in her nose.
Her mother had a hunch that, with the consistent symptoms, something was going on. While visiting the allergist about Harpers food allergies, Sane mentioned the strange reactions to the antibiotic. All it took was a five-minute test, recalls Sane. Her daughter is allergic to all antibiotics in the penicillin family and should avoid them in the future.
Sulfa Drugs Side Effects
Sulfa allergy and kidney damage are common sulfa drugs side effects. Read on to know more about the adverse effects of taking sulfonamides on the body and its interactions with several drugs.
Sulfa allergy and kidney damage are common sulfa drugs side effects. Read on to know more about the adverse effects of taking sulfonamides on the body and its interactions with several drugs.
Sulfa drugs or sulfonamides are medications used to treat bacterial and fungal infections. Prontosil was the first one discovered by German physician Gerhard Domagk in 1935. Though not known to kill bacteria, these medicines inhibit their growth and help in treatment of bacterial infections.
There are several known sulfa drugs side effects, but in spite of them, it is still used for the treatment of some form of malaria, urinary tract infection, ear infection, bacterial meningitis, and many other infections. Sulfisoxazole and combination drug sulfamethoxazole, and trimethoprim are the most common types of sulfonamides. These are available in liquid form or as tablets for oral and topical use. Septra, Pediazole, and Bactrim are the most common sulfa drugs available today.
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Foods To Avoid For A Sulfa Allergy
Sulfa drugs can cause allergic reactions in some people, including hives, swelling and difficulty breathing. If you’ve ever experienced a reaction to a sulfa drug, your doctor may have diagnosed you with a sulfa allergy. Inform other treating physicians of this allergy and your medical chart will be flagged with this information. If you’re ever hospitalized, you may wear a bracelet that informs hospital personnel that you have a sulfa allergy. But sulfa drugs and foods that contain sulfites or sulfates aren’t chemically related, so you don’t have to worry about sulfa in your diet.
Medical Malpractice Attorneys In Weston
If you suffered a severe allergic reaction to prescribed medication, especially if you told your physician about your allergy, this could be a viable medical malpractice claim and you could be entitled to fair and just compensation. At Rash Mueller, our team of medical malpractice attorneys in Weston is dedicated to fighting on behalf of the wrongfully injured and will do what it takes to ensure the responsible party is held accountable. Backed by 25 years of legal experience, you can trust that your case will be in good hands with us.
Start your medical malpractice case today and contact our team at 914-7116 to request a free initial case evaluation with a knowledgeable member of our team.
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Can You Be Allergic To Erythromycin
Erythromycin is well tolerated. The most common side effects are gastrointestinal distress, nausea, and vomiting, which are dose related. Allergic and pseudoallergic reactions due to macrolide antibiotics are uncommon. Anaphylaxis and acute respiratory distress appear in the literature as case reports.
Other Drug Interactions With Sulfa Drugs
There are many medicines which might have reactions with sulfa drugs. This increases the risk of side effect. Hence, precautions are taken by a physician while prescribing medicines. The following are some medications that have a higher possibility of interaction with sulfa drugs:
- Birth Control Pills
- Medication for alcohol abuse alcohol disulfiram
- Antiseizure valproic acid
- Diuretic Hydrochlorothiazide
Use of sulfa drugs can be limited, but cannot be stopped. Hence, it is important to take precautions to avoid sulfa drugs side effects. Always consult a doctor before taking any drugs if you suffer from allergies, asthma, kidney, and liver diseases. It is also advisable for breastfeeding mothers and pregnant ladies to avoid sulfa drugs as far as possible.
Disclaimer: This article is for informative purposes only, and should not be used as a replacement for expert medical advice.
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The 3 Most Common Causes Of Drug Allergies And How To Treat Them
Has your doctor ever asked if youre allergic to any drugs? Luckily for most people, medicine allergies are not that common. But for the few who do have them, allergic reactions can be extremely dangerous. Heres what you need to know about drug allergies before you start a new medication.
Other Drugs And Products With Names Stemming From Sulfur
Some drugs contain a sulfhydryl group or sulfate group in their chemical structure. These drugs have no relationship to sulfonamide allergy.
However sulfhydryl containing drugs can cause unrelated adverse skin reactions such as a rash or pemphigus .
Sulfates are also commonly found in soaps and cosmetics allergies to sulfates are extremely rare.
Sulfites are chemicals used as preservatives in food and drugs, such as sulfur dioxide and sodium sulfite. Allergy to sulfite preservatives can cause anaphylaxis, other rashes, asthma, seizures and death. People with asthma are at higher risk of sulfite allergy. Allergy to sulfites bears no relationship to sulfonamide allergy.
People who have had allergic reactions to sulfonamide-containing drugs do not need to avoid sulfhydryl drugs, sulfates or sulfites. To prevent confusion, the general term sulfa allergy should not be used. Instead it is better to note the exact drug and reaction involved.
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Other Types Of Sulfur Containing Substances
Elemental sulfur powder is commonly used in gardening, and while irritation may occur from skin contact or inhalation, allergy has not been described.
Sulfates are in some injectable drugs as sulfate compounds, such as heparin sulfate, dextran sulfate, morphine sulfate. The sulfates in soaps are strong detergents and can irritate the skin or eyes. However sulfate itself does not cause allergic reactions. It is usually safe to use a sulfate when a person has a sulfonamide allergy or a sulfite intolerance.
Sulfite preservatives are commonly known as sulfur dioxide and metabisulfites, with preservative numbers 220-228. Sulfites can be used to preserve flavour and colour within food, inhibit bacterial growth, stop fresh food from spoiling, and help preserve medication. Sulfites are most often found in wine, dried fruit, and dried vegetables. Sometimes they are used in sausages and salads. They can also occur naturally in low concentrations. Sulfites can cause adverse reactions which are like allergy but do not involve the immune system and are therefore called intolerances. The most common reactions are asthma symptoms and rhinitis reactions. Occasionally urticaria may occur, and very rarely, anaphylaxis .
There is no relationship between sulfite sensitivity and sulfonamide antibiotic allergy.
What Bacteria Does Erythromycin Target
Erythromycin is active against most gram-positive bacteria some gram-negative bacteria, including Neisseria, Bordetella, Bruceila, Campylobacter, and Legionella and Treponema, Chlamydia, and Mycoplasma. The emergence of resistance to erythromycin is closely associated with its use and is often plasmid mediated.
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Sulfa Vs Sulfite Allergy
Sulfa allergies and sulfite allergies arent the same thing. Sulfites occur naturally, or are used as a preservative agent in some foods and drinks. Sulfa medications and sulfites found in food and drink arent related to each other. The similarity between their names can cause some confusion. Read more about the difference between sulfa allergies and sulfite allergies.
Symptoms of sulfa allergy are similar to those of other drug allergies. Symptoms may include:
- skin rash or hives
- the drug sulfasalazine , used in the treatment of rheumatoid arthritis, Crohns disease, and ulcerative colitis
- the drug dapsone, used to treat dermatitis and some types of pneumonia
- the drug sumatriptan , used to treat migraines
- some anti-inflammatory drugs, such as celecoxib
- some diuretics, such as hydrochlorothiazide and furosemide
What Are Drug Allergies
When we talk about allergic reactions to drugs, were not talking about side effects. Side effects are the known common risks listed on the drugs labeling. Ibuprofen, for example, has the potential side effect of causing an upset stomach.
Drug allergies, in contrast, are caused by the bodys own immune system attacking a drug when it enters the body, as if the drug was a foreign invader. This sets of off a chain reaction that can lead to allergy symptoms ranging from mild to shocking.
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Seven Percent Of Patients Taking Sulfa Antibiotics Have Adverse Reactions
Approximately 6-8% of patients who take these drugs have adverse skin reactions ranging from a measles-like rash, hives and swelling, to severe life-threatening skin blistering conditions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. In HIV- infected patients, the adverse reaction rate to sulfonamide antibiotics is as high as 25 to 50 percent!
For a number of years, the drugs Bactrim DS and Septra DS were used to treat ear infections in children. Sulfamethoxazole is a sulfonamide antibiotic. If patients developed a rash while taking these drugs, they were told that they were allergic to sulfa and should avoid all sulfa drugs in the future. These antibiotics were widely prescribed and so the number of adults now reporting a history of sulfa allergy is significant.
Incidence And Risk Factors
Determining the true incidence of sulfonamide allergies is challenging, as allergy history is often self-reported by patients. A retrospective review of electronic medical records from patients receiving care in San Diego County through Kaiser Permanente aimed to determine the incidence and prevalence of self-reported antimicrobial allergies . The study evaluated 411,543 patients who had at least one outpatient visit during 2007. Antimicrobial allergy rates were calculated by determining the number of patients reported as having an allergy to the antimicrobial they were prescribed in 2007 divided by the sum of all patients who received that antimicrobial during 2007. The antimicrobial allergy rates were then stratified by gender to account for differences in incidence reporting. Sulfa allergy incidence among males and females was found to be 2.23 percent and 3.42 percent , respectively. Additionally, sulfa antimicrobials were associated with the highest incidence rates of antimicrobial allergies for both males and females compared to penicillin, cephalosporin, fluoroquinolone, tetracycline, and macrolide antimicrobials .
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Are Sulfas Found In Foods
Having an allergy to sulfa drugs is different from having an allergy to food or drinks that contain sulfites. Unless youve had a reaction to sulfites, consuming food or drink that contains sulfites is OK. Conversely, if youve had an allergic reaction to sulfites, it doesnt mean that youll also be allergic to sulfa drugs.
Drugs You Should Avoid If You Have Sulfa Allergies
If you are allergic to sulfa antibiotics, it is important to tell your doctor. These antibiotics have been used since 1936 and are widely used in burn creams, eye drops, vaginal suppositories, and medications for a vast range of infections. If you experience an allergic reaction to one sulfa drug, you are likely allergic to all of them, so make sure you avoid them.
Some of the most common sulfa drugs that frequently cause problems and interactions include:
- Sulfamethoxazole : This sulfa combination drug can be administered in either pill or liquid form for a vast array of infections.
- Sulfacetamide : This is a drop that is used to treat eye infections.
- Sulfadiazine silver : This is a cream that is used to prevent and treat burn infections.
- Sulfasalazine : This comes in pill form and is used to treat inflammatory bowel disease and rheumatoid arthritis.
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Causes Of Sulfa Allergy
A sulfa allergy takes place when your immune system identifies the drug as a dangerous substance. Thus, your body develops antibodies specific to the drug and attack against it.
The presence of sulfonamide in certain antimicrobial drugs can give rise to negative response when an individual has a sulfa allergy.
Such an allergic response takes place due to differences in the molecular structure between types of sulfonamides.
Chemically, sulfonamide antibiotics are different from other sulfonamides non-antibiotics because they have an arylamine group. This arylamine group is associated with hypersensitivity and allergies.
A cross-reactivity between arylamine sulfonamides is common and thus, its use must be avoided in individuals who are sensitive to it.
Drug List For Sulfa Allergy
This author has been verfied for credibility and expertise
Sulfa allergy is the allergic response that occurs from the presence of the compound structure SO2NH2. This compound can be found in the molecular makeup of many different drugs. The term “sulfa” was initially a description of a specific category of drugs, namely the sulfonamide group of anti-infective medications often used in the treatment of bacterial infections. However, there are other drugs whose chemical makeup contains molecules similar to SO2NH2 and are thus suspected of being able to cross-react in the body and elicit an allergic response.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
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Safe Medications For People With Sulfa Allergies
Not all drugs that contain sulfonamides cause reactions in all people. Many people with sulfa allergies and sensitivities may be able to safely take the following medications but should do so with caution:
- some diabetes medications, including glyburide and glimepiride
- migraine medication sumatriptan
- some diuretics, including hydrochlorothiazide and furosemide
The ability to take these medications can vary from person to person. If you have a sulfa allergy and are unsure if you should take any of these medications, talk with your doctor.
Symptoms of an allergic reaction to sulfites include:
- swelling of the mouth and lips
- wheezing or trouble breathing
- asthma attack
If you experience more serious symptoms of a sulfite allergy, contact your doctor. Anaphylaxis requires emergency medical attention.
According to the Cleveland Clinic, people with asthma have between a 1 in 20 and 1 in 100 chance of having a reaction to sulfites.
Sulfites are common in processed foods, condiments, and alcoholic beverages, such as red and white wine. Sulfites occur naturally in wine during fermentation, and many winemakers add them to help the process along.
For the past two decades, the Food and Drug Administration has required winemakers to display the warning contains sulfites if levels exceed a certain threshold. Many companies voluntarily add the label to their products as well.
- sulfur dioxide
Is It A Drug Allergy
Allergies to medications can be hard to diagnose because reactions do not all look the same. In fact, there are four different classes of allergic reactions all involving the immune system, but in quite distinct ways.
Type I: This form of allergic reaction is the most obvious. It involves IgE allergy antibodies and comes on as typical anaphylaxis: hives, difficulty breathing, swelling, closing of the throat, and can cause cardiac arrest and even death.
Anaphylactic drug reactions can occur very rapidly, often within minutes of exposure, says Dr. David Stukus, an assistant professor of pediatrics in the allergy section at Nationwide Childrens Hospital and Ohio State University. People can have anaphylactic reactions to any type of medication, but they most commonly occur with anesthesia that is being administered for surgery. Antibiotics are another top culprit.
Type II: This type of reaction is rare, and normally only seen in hospital patients. In a type II reaction, exposure to a certain medication will lead your immune system to form an antibody against itself.
For example, in an allergy to the anti-clotting medication heparin, the body forms antibodies that cause platelet levels to drop to dangerous levels. Other medications that can cause this type of reaction include the heart medication quinidine and the antibiotic vancomycin.
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Sulfa Allergy Diagnosis & Tests
It is important to quickly diagnose the condition and start with the treatment. Diagnosis relies on a careful history and physical examination.
History of Symptoms:
Your allergist may ask you details regarding the drug, such as:
- Name of the drugs taken
- Your doctors prescription
- The time when the drug was taken
- What symptoms were noticed first
- When did the symptoms appear?
- If any other multivitamin or herbal medications are taken
Your allergist may also ask you about other drug allergies and a family history of allergies.
All this investigation will give him a clear picture about your health status and drug allergy.
Besides this, there are no tests available that can be used to identify sulfa allergy.