磺胺类药物过敏和交叉过敏的研究进展

磺胺类药物是指含有-SO2NH2结构的药物。磺胺类药物的交叉过敏仍是困扰临床的一个用药难题。有磺胺类抗菌药过敏史的患者在临床上并不罕见,这些患者是否可以使用其他磺胺类药物,相关药品说明书的描述并不一致,也无标准的操作流程或指南。本文回顾了磺胺类抗菌药发生超敏反应的机制,发现其发生主要与磺胺类抗菌药N4位的芳香胺取代基和N1位的杂环取代基有关,而多数磺胺类非抗菌药(如呋塞米、噻嗪类利尿剂、塞来昔布等)并不含有这两个取代基,因此磺胺类抗菌药和非抗菌药之间发生交叉过敏的可能性较低。此外,本文也对磺胺类药物交叉过敏的相关临床研究进行了回顾。一个大规模的回顾性研究提示,有磺胺类抗菌药过敏史者使用磺胺类非抗菌药过敏反应的发生率较无磺胺过敏史者高,但并非与磺胺基团有关,而是和患者本身过敏反应易感性高有关。磺胺类抗菌药和非抗菌药之间发生交叉过敏的理论和循证依据尚不充分,但鉴于有磺胺类抗菌药过敏史的患者对药物过敏的易感性较高,这些患者是否可使用其他磺胺类药物,取决于相关药品说明书的规定、既往发生过敏反应的严重程度以及是否有其他替代药物。

Progress in sulfonamide hypersensitivity and cross-hypersensitivity

A sulfonamide is any compound with an -SO₂NH₂ moiety. The clinical significance of cross-reactivity of medications in a person with a "sulfa" allergy continues to perplex clinicians and complicates decisions regarding patient safety. Patients with hypersensitivity to sulfonamide antibacterials are not rare. The manufacturer's package inserts of different sulfonamides about concerning use in patients with a sulfonamide allergy are not consistent. There are no standard procedures or guidelines for the cautious administration of other sulfonamide-containing medications for patients hypersensitive to sulfonamide antibacterial. In this paper, we reviewed the etiology of sulfonamide antibacterial hypersensitivity. The major differences between sulfonamide antibacterials and other sulfonamide-containing medications (such as furosemide, thiazide diuretics and celecoxib) are that sulfonamide antibacterials contain an aromatic amine group at the N4 position and a heterocyclic ring at N1 position. These differences are considered to be critical in the development of hypersensitivity reactions to sulfonamide antibacterials. Cross-hypersensitivity between sulfonamide antibacterials and other sulfonamide-containing medications would not be expected to occur based on their chemical differences. The clinical data about sulfonamide cross-hypersensitivity were also reviewed. A retrospective cohort study has indicated that patients allergic to sulfonamide bacterials seem to be more likely to react to sulfonamide non-antibacterials than non-allergic patients. However, this high risk of allergic reactions appears to be due to a predisposition to allergic reactions rather than to cross-hypers ensitivity with sulfonamide-base drugs. From the evidence acquired, neither scientific evidence nor clinical research is enough to support the cross-hypersensitivity between sulfonamide bacterials and other sulfonamide-containing medications. Since a history of allergic reactions to sulfonamide bacterials may be at increased risk for other medications, whether other sulfonamide-containing medications can be used for patients with sulfonamide antibacterial allergy should depend on the contents of manufactures package inserts of sulfonamides, severity of the initial allergy and the presence of available alternatives.