Can my patient with a ‘sulfa allergy’ receive celecoxib or other nonantimicrobial sulfonamides?

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Figure 1
Chemical structures of antimicrobial and nonantimicrobial sulfonamides. Interclass reactivity and nonreactivity between antimicrobial and nonantimicrobial sulfonamides are shown. All sulfonamides contain an SO₂NH₂ an arylamine group at the N4 position (arrow), which serves as the primary target for immunoglobulin E–moiety. Antimicrobial sulfonamides (eg, sulfamethoxazole and sulfanilamide) contain mediated sensitization. Nonantimicrobial sulfonamides (eg, celecoxib, chlorothiazide, and furosemide) lack the arylamine group at the N4 position. For this reason, these drugs do not cross-react with antimicrobial sulfonamides.

TABLE 1

Gell and Coombs classification of hypersensitivity reactions

Type	Hypersensitivity reaction	Immune mechanism	Description
I	Immediate hypersensitivity	Immunoglobulin E–mediated reaction driven by immunoglobulin E bound to mast cells or basophils or both	Engagement of immunoglobulin E with its appropriate antigen leads to degranulation and release of histamine, leukotrienes, and other inflammatory mediators (eg, anaphylaxis)
II	Cytotoxic antibody	Antigen-antibody interaction	Local production of anaphylatoxin (C5a) and recruitment of polymorphonuclear leukocytes lead to release of hydrolytic neutrophil enzymes and subsequent tissue injury (eg, immune cytopenia)
III	Immune complex	Immunoglobulin G and M antibodies bind to antigen	Antigen-antibody complexes deposit in the glomerular basement membrane, pulmonary basement membrane, or both, leading to tissue injury and organ damage (eg, serum sickness reaction)
IV	Delayed hypersensitivity	Cell-mediated immune response	T cells are activated by an antigen-presenting cell; when antigen is presented again, memory T cells activate leukocytes (macrophages, neutrophils, eosinophils), leading to an inflammatory response with possible tissue injury via reactive oxygen species, lysosomal enzymes, and inflammatory cytokines (eg, tuberculin skin test, Rhus dermatitis, Stevens-Johnson syndrome or toxic epidermal necrolysis)

TABLE 2

Commonly prescribed antimicrobial and nonantimicrobial sulfonamides

Antimicrobial	Nonantimicrobial
Antimicrobial	Class	Examples
Sulfacetamide Sulfadiazine Sulfamerazine Sulfamethoxazole Sulfanilamide Sulfapyridine Sulfasalazine Sulfathiazole	Carbonic anhydrase inhibitors	Acetazolamide
	Cyclooxygenase-2 inhibitors	Celecoxib
	Loop diuretics	Bumetanide Furosemide Torsemide
	Sulfonylureas	Glipizide Glyburide
	Thiazide diuretics	Hydrochlorothiazide Chlorthalidone
	Triptans	Rizatriptan Sumatriptan
	Miscellaneous	Diazoxide Tamsulosin Zonisamide Metolazone Probenecid