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[2]: 118 The rash may also be one of the potentially lethal severe cutaneous adverse reactions, the DRESS syndrome, Stevens–Johnson syndrome, or toxic epidermal necrolysis. [3] [4] Systemic manifestations occur at the time of skin manifestations and include a high number of eosinophils in the blood, liver inflammation, and interstitial nephritis
It has therefore been argued that the terms "sulfonamide allergy" or "sulfa allergy" are misleading and should be replaced by a reference to a specific drug (e.g., "cotrimoxazole allergy"). [20] Two regions of the sulfonamide antibiotic chemical structure are implicated in the hypersensitivity reactions associated with the class.
A drug allergy is an allergy to a drug, most commonly a medication, and is a form of adverse drug reaction. Medical attention should be sought immediately if an allergic reaction is suspected. An allergic reaction will not occur on the first exposure to a substance.
The symptoms of DRESS syndrome usually begin 2 to 6 weeks but uncommonly up to 8–16 weeks after exposure to an offending drug. Symptoms generally include fever, an often itchy rash which may be morbilliform or consist mainly of macules or plaques, facial edema (i.e. swelling, which is a hallmark of the disease), enlarged and sometimes painful lymph nodes, and other symptoms due to ...
One study has shown the allergic reaction rate to be about 3.0% over 359 courses of therapy. [11] Of the allergic reactions, skin rashes, eosinophilia and drug fever were the most common, while serious reactions were less common. Sulfamethoxazole is contraindicated in people with a known hypersensitivity to trimethoprim or sulfonamides. [9]
Although the exact pathogenesis is poorly understood, serum sickness–like reactions are thought to originate from an abnormal inflammatory reaction that occurs in response to defective metabolism of drug byproducts generated during pharmacologic therapy; the metabolic flaw could be a maternally-inherited trait.
TEN and SJS are severe cutaneous drug reactions that involve the skin and mucous membranes. To accurately diagnose this condition, a detailed drug history is crucial. [4] Often, several drugs may be causative and allergy testing may be helpful. [4] Sulfa drugs are well known to induce TEN or SJS in certain people.