Sulfonamide Allergy Research Articles

Induction of Drug Tolerance to Trimethoprim/Sulfamethoxazole in Non-HIV Patients with a History of Sulfonamide Allergy

Induction of Drug Tolerance to Trimethoprim/Sulfamethoxazole in Non-HIV Patients with a History of Sulfonamide Allergy

Uccessful Treatment of Cerebral Toxoplasmosis with Clindamycin: A Case Report

Toxoplasmosis is caused by infection with the obligate intracellular parasite Toxoplasma gondii. Toxoplasmosis is generally a late complication of HIV infection and usually occurs in patients with CD4 + T-cell counts below 200/μl. Co-trimoxazole (trimethoprim plus sulfamethoxazole) is the most common drug used in India for the treatment of AIDS-associated cerebral toxoplasmosis. Other alternative drugs used for the treatment of cerebral toxoplasmosis are clindamycin plus pyrimethamine and clarithromycin with pyrimethamine.A 30-year-old male known case of retroviral disease presented to Kasturba Medical College, India, with complaints of fever, headache and vomiting. Computed tomography scan of his brain showed irregular ring enhancing lesion in the right basal ganglia. Toxoplasma serology revealed raised IgG antibody levels. Based on the CT features and serology, diagnosis of cerebral toxoplasmosis was made. He was treated with clindamycin alone as he had history of sulfonamide allergy. The patient was symptomatically better after 48 hours. After 21 days, repeat CT of brain was done which was normal. The patient showed good clinical improvement within 48 hours and the lesion resolved completely within 3 weeks. The authors recommend using clindamycin without pyrimethamine in resource poor settings and in patients who do not tolerate sulfa drugs.

Acetazolamide and Sulfonamide Allergy: A Not So Simple Story

Allergies and adverse reactions to sulfonamide medications are quite common. Two distinct categories of drugs are classified as sulfonamides: antibiotics and nonantibiotics. The two groups differ in their chemical structure, use, and the rate at which adverse reactions occur. Cross-reactivity between the two groups has been implied in the past, but is suspect. Acetazolamide, from the nonantibiotic group, is routinely used in the prevention and treatment of high altitude issues and may not need to be avoided in individuals with a history of sulfonamide allergy. This review addresses the differences between the groups and the propensity for intergroup and intragroup adverse reactions based on the available literature. We also examine the different clinical presentations of allergy and adverse reactions, from simple cutaneous reactions with no sequelae through Stevens-Johnson syndrome and anaphylaxis, with risk for significant morbidity and mortality. We offer a systematic approach to determine whether acetazolamide is a safe option for those with a history of allergy to sulfonamides.

Ethacrynic Acid as Potential Drug for Diuretic Renography in Instance of Sulfonamide Allergy

Ethacrynic Acid as Potential Drug for Diuretic Renography in Instance of Sulfonamide Allergy

Knowledge and attitudes of American pharmacists concerning sulfonamide allergy cross-reactivity

Pharmacists are commonly confronted with patients with a history of sulfonamide allergy. Basic immunologic and clinical data suggest a low likelihood of a patient with a history of sulfonamide hypersensitivity developing an allergic reaction to a non-antimicrobial sulfonamide drug. We conducted a survey to describe the knowledge and attitudes of licensed pharmacists concerning sulfonamide allergy cross-reactivity. A survey instrument was developed and sent to all licensed pharmacists in the state of Iowa. The survey recorded demographic information and included six patient scenarios designed to elicit responses concerning sulfonamide allergy cross-reactivity with a number of non-antimicrobial sulfonamides. A total of 421 surveys were returned for a 39% response rate. There was a wide discrepancy in approaches to patients with a history of sulfonamide allergy prescribed a sulfonamide containing non-antibiotic. Differences depended on previous history of tolerating the medication in question, the degree of cautionary statements in product literature, and the familiarity the pharmacist had with the product. Our survey suggests a significant diversity in knowledge and attitudes of pharmacists concerning cross-reactivity of sulfonamide antimicrobials and other drugs with a sulfonamide moiety. Depth of training in this area may be an associative factor.

Sulfonamide allergy and cross-reactivity

Concerns about cross-allergenicity between sulfonamide antibiotics and nonantibiotic sulfonamide-containing drugs continue to complicate pharmacotherapy. Several elegant investigations have demonstrated unequivocal lack of interaction between the sulfonamide group and either cellular or humoral immunity. The immunologic determinant of type I immunologic responses to sulfonamide antibiotics is the N1 heterocyclic ring, and nonantibiotic sulfonamides lack this structural feature. Many non-type I hypersensitivity responses to sulfonamide antibiotics are attributable to reactive metabolites that cause either direct cytotoxicity or humoral or cellular responses. Metabolite formation is stereospecific to the N4 amino nitrogen of the sulfonamide antibiotics, a structure not found on any nonantibiotic sulfonamide drugs. Cellular immune responses to sulfonamide antibiotics are responsible for many non-immunoglobulin E-mediated dermatologic reactions; however, the stereospecificity of T-cell response renders cross-reactivity between sulfonamide antibiotics and nonantibiotics highly unlikely. Apparent cross-reactivity responses to sulfonamide-containing drugs likely represent multiple concurrent, rather than linked, drug hypersensitivities.

Sulfonamide allergy without cross‐reactivity to celecoxib

Sulfonamide allergy without cross‐reactivity to celecoxib

The sulfone syndrome secondary to dapsone prophylaxis in a patient undergoing unrelated hematopoietic stem cell transplantation

Dapsone is commonly used for pneumocystis carinii pneumonia (PCP) prophylaxis in immunocompromised patients. It has been used as an alternative therapy in the hematopoietic stem cell transplant (HSCT) setting in patients who can't tolerate trimethoprim-sulfamethoxazole. The Sulfone syndrome is not a well-known sequela of dapsone therapy and occurs at various doses, ranging from 50-300 mg/d. In all cases the syndrome occurs within 2 months of initiating therapy. Its clinical manifestations include: fever, methemoglobinemia, hemolytic anemia, exfoliative dermatitis and transaminits. A 51-year old female underwent a matched unrelated hematopoiectic stem cell transplant for acute mylogenous leukemia. Dapsone therapy was initiated on day +28 at a dose of 100 mg/day for PCP prophylaxis secondary to the patient's history of a sulfonamide allergy. On day +59, one month after initiation of therapy she developed hepatitis, hemolytic anemia, fever and methemoglobinemia of 8%. She was transferred to the intensive care unit and subsequently developed an exfoliative dermatitis. We conclude that the clinical presentation of this patient after HSCT on dapsone therapy coincide with the sulfone syndrome not previously described in a patients after HSCT.

A phase II multicenter study of the cell cycle inhibitor indisulam in refractory metastatic breast carcinoma

685 Background: Indisulam (E7070) is a sulfonamide that inhibits cell cycle progression at multiple checkpoints by inducing expression of p53, p21 and suppressing expression of phosphorylated Rb, cyclins, and cyclin-dependent kinases. An exploratory, study in refractory breast cancer revealed a 15% response rate, with 40% stable disease. We therefore conducted an open-label, Phase II study of indisulam in metastatic breast cancer refractory to standard therapy.Methods: The primary endpoint is response rate, to be independently evaluated via RECIST criteria after accrual of 42 and 110 patients (pts). Secondary endpoints include progression free survival (PFS), time to progression (TTP), median/six month survival, Quality of Life (QOL), using FACT-B analysis, and safety. Eligibility criteria: KPS ≥ 70%. Patients were required to have prior chemotherapy with an anthracycline, taxane and fluoropyrimidine. Any number of prior regimens was permitted. Pts initially received indisulam 800 mg/m2 every 3 weeks. However dose-limiting toxicity observed in the first 3/7 patients led to dose reduction to 700 mg/m2.Results: To date, 49 pts have been enrolled. Results thus far are based on data from 26 pts who have received a total of 1 cycle, 11 pts who have received 2–3 cycles and 2 pts who have received 4–6 cycles. Of 15 pts evaluable for response, 6 have had a best response of stable disease (5 ongoing), 6 pts discontinued with disease progression, and 3 with toxicity. Attributable CTC Grade 3 or 4 adverse events were reported in a total of 6 patients with 8 events. These included neutropenia (3), thrombocytopenia (2), febrile neutropenic sepsis, with hypotension (1), hyperbilirubinemia with encephalopathy (1), sulfonamide allergy (1), and death (1). Analysis of response rates, PFS, TTP, QOL, and six-month survival is ongoing.Conclusions: Indisulam toxicity is acceptable. Efficacy analysis is continuing. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Eisai Medical Research Eisai Medical Research

Early-Onset Pentamidine-Associated Second-Degree Heart Block and Sinus Bradycardia: Case Report and Review of the Literature

Although various manifestations of pentamidine-induced cardiotoxicity have been reported, to our knowledge, second-degree heart block associated with this agent has not been described. In addition, cardiac adverse effects usually develop after at least 6 days of therapy. We describe a 54-year-old, human immunodeficiency virus-positive man with a history of sulfonamide allergy who received treatment with pentamidine for Pneumocystis jiroveci pneumonia. After only the third dose of pentamidine, it was noted that the patient's heart rate had decreased to 48 beats/minute. Subsequently, five episodes of Wenckebach (Mobitz type 1) heart block with a ventricular rate of 28 beats/minute were observed on continuous cardiac telemetry. Serum electrolyte and creatinine levels remained within normal limits. Within 4 days of discontinuing the pentamidine, the patient's heart rate stabilized at 80 beats/minute without further intervention. Clinicians should be vigilant when monitoring for cardiotoxicity in patients receiving pentamidine throughout the duration of therapy. In addition, they should continue to reserve its use for moderate-to-severe Pneumocystis jiroveci pneumonia for which trimethoprim-sulfamethoxazole is ineffective or contraindicated.

Sulfonamide Cross-Reactivity: Fact or Fiction?

To provide a critical and comprehensive review of the literature, specifically case reports and observational studies used to support the concept of cross-reactivity between sulfonylarylamines and non-sulfonylarylamines. A list of medications was formulated from several different review articles. A MEDLINE/PubMed search was conducted (1966-March 2004) using the individual medications and the MeSH terms of drug hypersensitivity/etiology, sulfonamides/adverse effects, and/or cross-reaction. A critical review of the methodology and conclusions for each article found in the search was conducted. The manufacturer's package insert (MPI) for each drug was examined for a statement concerning possible cross-reactivity in patients with a sulfonamide allergy. If indicated, the manufacturers were contacted to obtain any clinical data supporting the statement. A total of 33 medications were identified. Seventeen (51.5%) of the MPIs contained statements of varying degrees concerning use in patients with a "sulfonamide" allergy; 21 case series, case reports, and other articles were found. After a thorough critique of the literature, it appears that the dogma of sulfonylarylamine cross-reactivity with non-sulfonylarylamines is not supported by the data. While many of the case reports on the surface support the concept of cross-reactivity, on closer examination the level of evidence in many of the cases does not conclusively support either a connection or an association between the observed cause and effect.

Identification of Sulfonamide-like Adverse Drug Reactions to Celecoxib in the World Health Organization Database

SummaryBackground: The selective COX-2 inhibitor celecoxib has a sulfonamide structure and is contraindicated for patients with known sulfa allergy. However, there is currently no standard available for the identification of sulfonamide-related adverse drug reactions (ADRs) and the occurrence of such ADRs with celecoxib has not been established.The aims of this study were: (1) to identify the typical pattern of sulfonamide ADRs from literature and verify this pattern in the World Health Organization (WHO) ADR database; and (2) to examine whether these sulfonamide ADRs occur more frequently with celecoxib than with the non-sulfonamide, COX-2 inhibitor rofecoxib.Methods: A sulfonamide ADR pattern was derived from the most extensive textbook source of ADRs and applied to the WHO database for the three groups of sulfonamide drugs: short- and intermediate-acting sulfonamides, and sulfasalazine. ADRs reported three or more times for each of these groups were included in a ‘sulfonamide template’ comprising 19 ADRs relating to the skin the blood the liver and anaphylaxis. This template was then applied to celecoxib and rofecoxib.Results: Overall, the relative reporting rate of a sulfonamide-type ADR with celecoxib was 80% higher than with rofecoxib, whether this was based on total number of reports (RR 1.8, 95% CI 1.6-1.9) or restricted to reports that listed coxibs as the sole suspected drugs (RR 1.8, 95% CI 1.6-1.9). There were numerically more ADRs for celecoxib than for rofecoxib in 15 of the 19 terms. Within the ADRs in the sulfonamide template, relative reporting rate of fatal reactions was 80% higher with celecoxib (RR 1.8, 95% CI 0.9-4.0). Even though serious sulfonamide reactions are rare, their clinical impact on patient safety warrants close monitoring as more data becomes available. Physicians should be aware of possible sulfonamide allergy when prescribing celecoxib.

Identification of Sulfonamide-like Adverse Drug Reactions to Celecoxib in the World Health Organization Database

SummaryBackground: The selective COX-2 inhibitor celecoxib has a sulfonamide structure and is contraindicated for patients with known sulfa allergy. However, there is currently no standard available for the identification of sulfonamide-related adverse drug reactions (ADRs) and the occurrence of such ADRs with celecoxib has not been established.The aims of this study were: (1) to identify the typical pattern of sulfonamide ADRs from literature and verify this pattern in the World Health Organization (WHO) ADR database; and (2) to examine whether these sulfonamide ADRs occur more frequently with celecoxib than with the non-sulfonamide, COX-2 inhibitor rofecoxib.Methods: A sulfonamide ADR pattern was derived from the most extensive textbook source of ADRs and applied to the WHO database for the three groups of sulfonamide drugs: short- and intermediate-acting sulfonamides, and sulfasalazine. ADRs reported three or more times for each of these groups were included in a ‘sulfonamide template’ comprising 19 ADRs relating to the skin the blood the liver and anaphylaxis. This template was then applied to celecoxib and rofecoxib.Results: Overall, the relative reporting rate of a sulfonamide-type ADR with celecoxib was 80% higher than with rofecoxib, whether this was based on total number of reports (RR 1.8, 95% CI 1.6-1.9) or restricted to reports that listed coxibs as the sole suspected drugs (RR 1.8, 95% CI 1.6-1.9). There were numerically more ADRs for celecoxib than for rofecoxib in 15 of the 19 terms. Within the ADRs in the sulfonamide template, relative reporting rate of fatal reactions was 80% higher with celecoxib (RR 1.8, 95% CI 0.9-4.0). Even though serious sulfonamide reactions are rare, their clinical impact on patient safety warrants close monitoring as more data becomes available. Physicians should be aware of possible sulfonamide allergy when prescribing celecoxib.

Amprenavir: A new human immunodeficiency virus type 1 protease inhibitor

This paper reviews the pharmacologic properties and clinical usefulness of amprenavir, a new human immunodeficiency virus type 1 (HIV-1) protease inhibitor. Amprenavir, the most recent HIV-1 protease inhibitor to receive marketing approval from the US Food and Drug Administration, is a potent competitive inhibitor of HIV-1 protease and a relatively weak inhibitor of HIV-2 protease. Inhibition of the HIV-1 protease enzyme results in immature and noninfectious viral particles. Amprenavir is rapidly absorbed following oral administration. The time to peak concentration (Tmax) in adults is between 1 and 2 hours, the area under the plasma concentration versus time curve is roughly proportional to the dose, the half-life is approximately 8 hours, and the volume of distribution is approximately 430 L. The Tmax in children 4 to 12 years of age is between 1.1 and 1.4 hours. The bioavailability of the solution is 86% relative to the capsule formulation. It is metabolized by the cytochrome P-450 isozyme CYP3A4 and to a lesser extent by CYP2D6 and CYP2C9. We searched MEDLINE (1966 to January 2000), AIDSLINE (1980 to January 2000), International Pharmaceutical Abstracts (1970 to January 2000), PharmaProjects (January 2000 version), and Web sites of major HIV/acquired immunodeficiency syndrome conferences for appropriate published references (1996 to February 2000). Data reported to date indicate that amprenavir is efficacious in the treatment of HIV disease in patients with primary HIV infection, antiretroviral-naïve patients, protease inhibitor-naïve patients, protease inhibitor-experienced patients, and pediatric patients. Adverse effects were usually of early onset (range, 2 to 21 days) and transient (range, 3 to 46 days), although the incidence of metabolic abnormalities such as lipodystrophy, hyperlipidemia, and diabetes mellitus has not yet been defined. Amprenavir should be avoided in patients with a known sulfonamide allergy. Concomitant use of other medications that are CYP3A4 inducers or inhibitors should be done cautiously and only if the potential benefit clearly outweighs potential risk. The dose should be reduced in patients with significant hepatic impairment (Child-Pugh score, > or = 5). Amprenavir probably should not be administered with rifabutin, rifampin, astemizole, midazolam , triazolam, bepridil, dihydroergotamine, ergotamine, or cisapride. The recommended adult dose is 1200 mg twice daily. For patients between 4 and 12 years of age or between 13 and 16 years of age who weigh < 50 kg, the recommended dosage of the capsule form is 20 mg/kg (22.5 mg/kg for oral solution) twice daily or 15 mg/kg (17 mg/kg for oral solution) 3 times a day to a maximum dose of 2400 mg (2800 mg for oral solution). Patients should not take vitamin E supplements because amprenavir is formulated with a large amount of vitamin E (109 IU/capsule and 46 IU/mL oral solution) to improve oral absorption. Amprenavir may be administered with or without food, but a high-fat meal (> 67 g fat) should be avoided. Published clinical data are limited, but amprenavir appears to be efficacious and generally well tolerated in patients with HIV infection. Pharmacoeconomic data are not yet available. The introduction of amprenavir appears to be important, since it provides an additional treatment option as a component of both initial and salvage combination therapies for patients with HIV.

Allergic manifestations of human immunodeficiency virus (HIV) infection

Drug allergy is the most common and significant allergic manifestation of HIV3 infection. Initially described in patients treated with SMX-TMP for PCP, allergy is now known to involve a multitude of drugs. The pathogenesis of, and risk factors for, allergy in HIV infection are poorly understood, although there is evidence suggesting that allergy is more common with advancing immunodeficiency. HIV-negative subjects with sulfonamide allergy may have drug-specific antibodies and drug metabolite-induced lymphocyte cytotoxicity, abnormalities that could partly explain the allergic mechanisms and which may have future diagnostic potential; these abnormalities have not been described in HIV-infected subjects. Therapy includes avoidance, suppressive agents such as corticosteroids, and desensitization, although the appropriate role for each is not entirely clear. Serum IgE levels have been shown to rise with progressive disease; those patients with higher levels may have a worse prognosis. The mechanisms of this rise are multifactorial, probably a combination of altered T-lymphocyte regulation of IgE synthesis and of production of specific IgE directed against microbial antigens.

Ethacrynic acid-induced convulsions

This is an updated comprehensive review of the adverse effects of diuretics from 2013–2014. This includes five different groups of diuretics, carbonic anhydrase inhibitors (CAI) which discusses acetazolamide as the only current CAI still used for its diuretic effect. Loop diuretics (furosemide, bumetanide, torsemide, azosemide, and ethacrynic acid), thiazide and thiazide-like diuretics (hydrochlorothiazide, chlorthalidone, chlorothiazide and indapamide), aldosterone receptor antagonists (spironolactone and eplerenone) and the osmotic diuretic, mannitol. Intravenous infusion of furosemide in acute heart failure has shown to be associated with acute kidney injury (AKI), especially with high doses and longer duration of therapy. However, this therapy continues to prove to be very effective at decreasing symptomatic dyspnea in this patient population. Ethacrynic acid, a loop diuretic primary reserved for patients with substantial sulfonamide allergy, can predispose patients to metabolic alkalosis and serious skin reactions. This publication also reviews thiazide and thiazide-like diuretics and their effects on the metabolic, electrolyte and hemodynamic parameters. The aldosterone receptor antagonists show new insight into potentially new drug–drug interactions and an increased risk of gynecological cancers in young female patients treated with spironolactone. Inhaled mannitol may predispose patients to bronchospasm and haemoptysis in the cystic fibrosis patient population.

The management of patients with sulfonamide allergy.

To illustrate the variety of clinical strategies that may be used in treatment of patients allergic to sulfa medications, we report the management of eight sulfa allergic patients, seven of whom required readministration of the sulfa drug. Slow oral readministration of a sulfonamide over the course of four weeks was successful in two patients who had a history of cutaneous reactions to sulfa use and did not require sulfa urgently. Rapid oral or intravenous readministration of a sulfonamide was attempted unsuccessfully in three patients, each of whom urgently needed continuation of a sulfa drug. Occasionally a sulfa drug must be continued despite the presence of a cutaneous drug eruption secondary to that drug. In four patients, including two of the patients in whom rapid test dosing of a sulfonamide had been unsuccessful, treatment of the sulfa reaction with corticosteroids and antihistamines permitted continued sulfa administration. Readministration of a sulfonamide should not be attempted in patients who previously have had reactions such as Stevens-Johnson syndrome unless essential for survival of a patient.

Trimethoprim-Sulfamethoxazole for Acute Dysuria in Women: A Single-Dose or 10-Day Course

To compare single-dose and 10-day treatment regimens of trimethoprim-sulfamethoxazole in women with acute dysuria, urgency, or urinary frequency. Double-blind, randomized, placebo-controlled trial. Student health center at a major university. Consecutive sample of 255 young women including 216 with a bacteriologically documented urinary tract infection. Single-dose treatment (trimethoprim, 320 mg and sulfamethoxazole, 1600 mg) given to 116 women and 10-day treatment (trimethoprim, 160 mg and sulfamethoxazole, 800 mg, twice daily) given to 125 women. Women with a history of sulfonamide allergy were given trimethoprim alone: 10 received single-dose treatment (200 mg) and 5 received 10-day treatment (100 mg, twice daily). The rates for resolution of symptoms at 3 days, 13 days, and 6 weeks after entry into the study were not significantly different between treatment groups. Among women with urinary tract infections, cumulative crude rates of recurrence in the single-dose and 10-day treatment groups, respectively, were 24% compared with 5% at 13 days after entry (P = 0.0002; 95% confidence interval [CI] for difference in proportions, 10%, 28%) and 32% compared with 21% at 6 weeks after entry (P = 0.07; 95% Cl, -2%, 24%). Factors independently associated with lower cure rates were a history of a urinary tract infection within the previous 6 weeks (adjusted odds ratio [OR], 3.8; 95% Cl, 1.4 to 10.6) and presence of 10(5) bacteria/mL or greater in an initial midstream culture (adjusted OR, 2.9; 95% Cl, 1.2 to 7.0). After controlling for these factors, the risk of failure after single-dose treatment was not statistically significantly different from 10-day treatment at 6 weeks (adjusted OR, 1.6; 95% Cl, 0.8 to 3.2; P = 0.21). Compared to 10-day treatment, single-dose treatment less effectively eradicated Escherichia coli from the vaginal flora (P less than 0.001) and led more often to early same-strain recurrences (P = 0.003). Meaningful adverse effects occurred in 12% of women given single-dose treatment compared with 25% of women receiving 10-day treatment (P = 0.009). Compared with single-dose treatment, 10-day treatment yields a superior cure rate at 2 weeks after the start of treatment, but by 6 weeks the advantage of longer treatment no longer exists. This effect may be explained by the lesser effectiveness of single-dose treatment in eradicating vaginal E. coli, resulting in more frequent same-strain recurrences within 2 weeks of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

PACHYMENINGITIS APPARENTLY DUE TO PENICILLIN HYPERSENSITIVITY

Case Reports1 April 1960PACHYMENINGITIS APPARENTLY DUE TO PENICILLIN HYPERSENSITIVITYLAURENCE FARMER, M.D., FRANCIS A. ECHLIN, M.D., WINIFRED C. LOUGHLIN, M.D., ARNOLD S. BREAKEY, M.D., ROGER DUVOISIN, M.D.LAURENCE FARMER, M.D.Search for more papers by this author, FRANCIS A. ECHLIN, M.D.Search for more papers by this author, WINIFRED C. LOUGHLIN, M.D.Search for more papers by this author, ARNOLD S. BREAKEY, M.D.Search for more papers by this author, ROGER DUVOISIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-52-4-910 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptClinical and experimental observations(1-10) have established that protracted allergic reactions to drugs and foreign proteins may result in a variety of inflammatory and necrotizing tissue lesions. Such lesions, due to hypersensitivity to sulfonamides, penicillin, iodine, foreign sera and egg albumin, have been demonstrated mainly in the heart, lungs, kidneys, liver and spleen. In a patient under our observation there developed a marked pachymeningitis of the dura mater over both cerebral hemispheres, and a severe scleritis, apparently the result of an allergic reaction to penicillin.CASE REPORTA 47 year old woman suffering from excruciatingly severe, unrelenting headache was admitted to...Bibliography1. Rich AR: The role of hypersensitivity in periarteritis nodosa, Bull. Johns Hopkins Hosp. 71: 123, 1942. Google Scholar2. Rich AR: Additional evidence of the role of hypersensitivity in the etiology of periarteritis nodosa, Bull. Johns Hopkins Hosp. 71: 375, 1942. Google Scholar3. Rich AR: Hypersensitivity to iodine as a cause of periarteritis nodosa, Bull. Johns Hopkins Hosp. 77: 43, 1945. Google Scholar4. RichGregory ARJE: Experimental evidence that lesions with the basic characteristics of rheumatic carditis can result from anaphylactic hypersensitivity, Bull. Johns Hopkins Hosp. 73: 239, 1943. Google Scholar5. GregoryRich JEAR: The experimental production of anaphylactic pulmonary lesions with the basic characteristics of rheumatic pneumonitis, Bull. Johns Hopkins Hosp. 78: 1, 1946. MedlineGoogle Scholar6. FrenchWeiler AJCV: Interstitial myocarditis following the clinical and experimental use of sulfonamide drugs, Am. J. Path. 18: 109, 1942. MedlineGoogle Scholar7. French AJ: Hypersensitivity in the pathogenesis of the histopathologic changes associated with sulfonamide chemotherapy, Am. J. Path. 22: 679, 1946. Google Scholar8. MooreMcMillanDuff RHGCGL: The pathology of sulfonamide allergy in man, Am. J. Path. 22: 703, 1946. Google Scholar9. HawnJaneway CVCA: Histological and serological sequences in experimental hypersensitivity, J. Exper. Med. 85: 571, 1947. CrossrefMedlineGoogle Scholar10. Waugh D: Myocarditis, arteritis and focal hepatic, splenic and renal granulomas due to penicillin sensitivity, Am. J. Path. 28: 437, 1952. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication October 31, 1958.From the Lenox Hill Hospital, New York, N. Y.Requests for reprints should be addressed to Laurence Farmer, M.D., 993 Park Avenue, New York 28, N. Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byNeurological Adverse Effects Attributable to β-Lactam Antibiotics: A Literature ReviewContrast enhanced FLAIR imaging in ibuprofen induced aseptic meningitisDrug-induced aseptic meningitisDrug-Induced Aseptic MeningitisDrug-induced meningitisDrug- and Chemical-Induced Aseptic Meningitis: A Review of the LiteratureDrug-induced aseptic meningitisAseptic meningitis with retinal ischemia due to trimethoprim-sulfamethoxazoleRecurrent Encephalitis due to Trimethoprim IntakeTrimethoprim-sulfamethoxazole-associated aseptic meningitis: Case reports and review of the literatureTrimethoprim Associated Aseptic MeningitisPENICILLIN ALLERGY: A REVIEW OF THE IMMUNOLOGICAL AND CLINICAL ASPECTSInfluence of Penicillin Allergic Reactions on Venereal Disease Control Programmes 1 April 1960Volume 52, Issue 4Page: 910-914KeywordsAllergy and immunologyHypersensitivityLesionsMeningitisPenicillinSpleenSulfonamideTuberculosisUrticariaVision ePublished: 1 December 2008 Issue Published: 1 April 1960 PDF downloadLoading ...

The pathology of sulfonamide allergy in man

The pathology of sulfonamide allergy in man