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Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?
Journal article   Peer reviewed

Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?

Andrew G Lee, Randy Anderson, Randy H Kardon and Michael Wall
American journal of ophthalmology, Vol.138(1), pp.114-118
07/2004
DOI: 10.1016/j.ajo.2004.02.019
PMID: 15234289

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Abstract

To determine whether acetazolamide or furosemide produce allergic cross-reactions in patients with self-reported "sulfa allergy." Retrospective case series. 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). 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. 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.
 Cross Reactions Drug Hypersensitivity - etiology Intracranial Hypertension - drug therapy Acetazolamide - adverse effects Furosemide - adverse effects Acetazolamide - chemistry Humans Diuretics - chemistry Retrospective Studies Self Disclosure Furosemide - chemistry Diuretics - adverse effects

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