Original articlePresumed “sulfa allergy” in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?☆
Section snippets
Methods
A retrospective chart review was performed of all patients with the diagnosis of presumed idiopathic intracranial hypertension from 1972 to 2003 at the University of Iowa Hospitals and Clinics, Department of Ophthalmology, Division of Neuro-Ophthalmology. This study was performed with appropriate institutional review board approval and in compliance with applicable Health Insurance Portability and Accountability Act regulations. Inclusion criteria were as follows: 1) a clinical diagnosis of
Results
We reviewed 363 charts. All patients had been seen between 1972 and 2003 at the Department of Ophthalmology at the University of Iowa Hospitals and Clinics, Iowa City, Iowa. Patient follow-up ranged from 7 weeks to 21 years, with a median of 2.5 years, and a mean of 4.13 years. Of these 363 patients, 322 (89%) were excluded because of absence of self-reported sulfa allergy. Of the remaining 41 (11%) charts of patients with self-reported sulfa allergy, 5 additional charts were excluded because
Discussion
Although the literature on the treatment of idiopathic intracranial hypertension suggests that patients with sulfa allergy should not take acetazolamide or furosemide, the evidence supporting this recommendation is weak. The same product warnings appear for other sulfonamide nonantimicrobial agents used in ophthalmology, including brinzolamide, dorzolamide, and methazolamide.1
The majority of patients who report a sulfa allergy have actually had an adverse reaction to a sulfonamide antimicrobial
Biosketch
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2018, Handbook of Clinical NeurologyCitation Excerpt :Acetazolamide, a carbonic anhydrase inhibitor, is a sulfonamide with distinct biochemical structure and pharmacologic properties from antimicrobial sulfonamides. Although there may be a theoretic basis for the concern of cross-reactivity, there has been little evidence for adverse effects of acetazolamide in patients with sulfa allergy (Lee et al., 2004). For those who do not respond to or are unable to tolerate acetazolamide, an alternative is 4-aminopyridine.
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2017, Pediatric NeurologyCitation Excerpt :Thus the pharmacologic literature provided with both medications suggests that individuals with a sulfa allergy should refrain from taking these medications. Lee et al.135 reviewed the charts of patients with intracranial hypertension and self-reported sulfa allergy who were given regimens of acetazolamide, furosemide, or a combination of acetazolamide and furosemide. They did not find any evidence of cross-reactivity in their patients and suggest use in these patients can be done safely.
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