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Sulfa Allergy & Cross-Reactivity

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Sulfa Allergy & Cross-Reactivity Sulfa allergy & Cross-reactivity ภญ. ทนมณิ ี ทนกริ ศนยู แพยา รพ. ศริ ิราช 1 Presentation outline • Introduction to sulfa • โครงสรางพื้นฐานของกลุมยา sulfonamides • ประเภทของยากลุม sulfonamides • การแพการแพยายา sulfa • การแพยาขามกัน • การปฏิบัติเมื่ือพบผปู วยที่ปี ระวัติแพยา SlfSulfa • สรุป 2 Introduction • Sulfa allergy = Sulfonamide antibiotics allergy • 8% of hosppppitalized pt. reported have ADR (skin+GI tract) to Bactrim® (Sulfamethoxazole/Trimethoprim) , 3% are hypersensitivity reaction1 • เปนยาทมี่ ีรายงานการแพเปน อันดับ 2 รองจากกลุม Cephalosporins2 3 1.Immunol Allergy Clin N Am 2004; 24:477-490 2. J Med Assoc Thai 2005; 88(11) : 1642-1650 What is Sulfonamide ? Sulfanilamide ( Sulfonamide basic structure) c Sulfonamide group 4 Sulfonamides classifications • แบงประเภทตาม โครงสรางทางเคมี และ ขอบงช้ีในการใชยา 1. Sulfonamide antibiotics 2. Sulfonamide non-antibiotics 5 Sulf onami de anti bi oti cs • Sulfamethoxazole (Bactrim®) • Sulfadiazine • Sulfapyridine (Sulfasalazine; Salazopyrin EN®) 6 Sulfonamide non -antibiotics • Loop diuretics – Furosemide (Lasix®) – TidTorsemide (Unat®) • Thaizide diuretics – Hydrochlorothaizide (HCTZ) – Indapamide (Natrilix®) • Carbonic anhydrase inhibitors – Acetazolamide (Diamox®) – Dorzolamide (Cozopt®) – Brinzolamide (Azopt®, Azagra®) 7 Sulfonamide non-antibiotics • Sulfonylureas – Chlorpropamide (Diabenese®) – Glibenclamide (Daonil®) – Glipizide (Minidiab®) – Gliclazide (Diamicron®) – Glimeperide (Amaryl®) 8 Sulfonamide non-antibiotics • Cox-II inhibitors – Celecoxib (Celebrex®) – Parecoxib (Dynastat®) • Others – Topiramate (Topamax®) – Zonisamide (Zonigrane®) – Dapsone 9 Sulfonamide antibiotic VS non-antibiotic What’ s the difference ? 5 or 6 membered ring with N Arylamine 10 Sulfonamide antibiotics Sulfadiazine Sulfamethoxazole (Bactrim®) 11 Sulfonamide non -antibiotics HCTZ AtAcetazo lam ide FidFurosemide 12 Sulfonamide non -antibiotics Zonisamide TiTopirama te ClCelecox ib 13 (celebrex®) Parecoxib (Dynastat®) Propose mechanism of sulfonamide hitiithypersensitivity กระตุนระบบภูมู ิคมกุุ ัน 14 Immunol Allergy Clin N Am 2004;24:477-490 Sulfonamide Hypersensitivity • ตตาแหนงทมความสาคญตอการแพยาําแหนงท ี่มีความสําคัญตอการแพยา sulfonamides – N1 substitute : 5-6 membered ring with N – N4 : AlArylam ine Sulfonamide antibiotics Only!!! – ดังน้ัน ใน ทางทฤษฎี หาก ผป. มประวี ัติแพยาในกลุม Sulfonamide antibiotics จะเกิดการแพขามกันเฉพาะในกลุม Sulfonamide ATB เทาน้ัน!!! 15 What’s about evidence base? • Retrospective cohort study • 969 pt. w ith a llerg ic to su lfonam ide ATB • Objective: To examine a prior reaction to sulfonamide ATB as a risk factor for subsequent reaction to sulfonamide non-ATB 16 N Engl J Med 2003;17: 1628-1635 What’s about evidence base? 17 N Engl J Med 2003;17: 1628-1635 What does manufacturer say? 18 What does manufacturer say? 19 What does manufacturer say? 20 When Theory meet the Law N4 Name N1 Product information (arylamine) Sulfonamide antibiotics Sulfamethoxazole (Bactrim®) C* SlfdiiSulfadiazine C* Sulfasalazine (Salazopyrin EN®) C* Sulfonamide non -antibiotics Thiazide diuretics: Indapamide (Natrilix SR®) C* HCTZ C* Loop diuretics: Furosemide (Lasix®) C* TidTorsemide (UtUnat®) - Carbonic anhydrase inhibitors: Acetazolamide - Brinzolamide (Azopt®) P** Dorzalamide (Cosopt®) P** 21 When Theory meet the Law N4 Product Name N1 (arylamine) information Sulfonylureas: Chlorpropamide (Diabenese®) - Glibenclamide (Daonil®) P** Glipizide (Minidiab®) - Gliclazide (Diamicron, Diamicron MR®) C* Glimepiride (Amaryl®) C* Cox-2 inhibitors: ClCelecox ib(ClbCelebrex ®) C* Parecoxib (Dynastat®) C* Other agents: TiTopiramate (T®Topamax®) - Zonisamide C* Dapsone P** 22 C* = Contraindication = หามใชยานี้ในผูปวยที่แพยากล ุม sulfonamide อื่น P** = Precaution = คําเตือน ระวังในการใชยานี้ในผูปวยที่มประวี ัติแพยากลุม sulfonamide อื่น What should we do in general practice ? 23 Conclusion • Sulfa allergy = Sulfonamide ATB allergy • ตามทฤษฎีแลว : การแพยาขามกันในกลุม Sulfa เกิดขึ้นเฉพาะ ในกลุมยา sulfonamide ATB เทาน้ัน • แตในเอกสารกํากับยาของกลุม Sulfonamide non-ATB ระบุให ผป. ที่มี ประวัติแพยา Sulfa จัดอยูในกลุม ขอห ามใช หรือ ขอควรระวงในการใชั ยา • ดังนั้น ในแงการปฏิบัติงาน เราอาจตองคํานึงถึงขอกฎหมายรวมดวยเมื่อมีการสั่ง จายยา Sulfonamide non-ATB ใหแกผป. ที่มประวี ัติแพยา Sulfa 24 Thank you for yorour attentions 25.
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