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wag11c
02-08-2006, 02:56 PM
Sulfite allergies: Have a pt who states is allergic to sulfa drugs, is not able to tell you the true extent-anyphylactic or just hives. Pt having chest pain refractory to nitrates. Do you give this person Morphine Sulfate? I know it is an inactive ingredient in a lot of the meds we carry, but could it have a detrimrntal effect on the pt? I also know that may who are allergic to sulfites have such a diverse response. Have not been able to find a definitive answer in my researsch. Our QA a-hole banged me for this last week, I asked him what he would have done if the pt started to have a reaction anad was wheezing. His answer? I would have given Albuterol via neb. To which I replied- Albuterol Sulfate? Help me Dasharkie or Mittle.

Tiredoldman
02-08-2006, 03:22 PM
I found this on another website (ems village) from a while back. Hope this helps.

People that are allergic to sulfa drugs are allergic to sulfonamides. Several different classes of drugs are sulfonamides. They include antibiotics like Septra and Bactrim, diuretics like Lasix and HCTZ, and antihyperglycemics like glipizide and glyburide. Sulfonamides are inhibitors of para-amino benzoic acid and have been widely used as antibiotics since the Second World War. The sulfa powder that US soldiers carried was sulfonamide.
Drugs that end in sulfate, like morphine sulfate, atropine sulfate, and albuterol sulfate have a –sulfate or SO4 group attached to them. This is not the same as being a sulfonamide.
There have not been any reported cross-reactions for patients with an allergy to sufonamides being given sulfates.
There is also a concern that allergy to sulfonamide antibiotics means that patients could also be allergic to other sulfonamide derivatives. This could be important to EMS providers since Lasix is one of these sulfonamide nonantibiotics.
In a recent review in the Immunology and Allergy Clinics of North America, the authors concluded from a review of the literature that,” The preponderance of available evidence suggests that sulfonamide antibiotics probably do not cross-react with sulfonamide nonantibiotics.”
So to summarize, patients allergic to sulfa can receive drugs that end in sulfate without problems. Patients allergic to sulfonamide antibiotics can probably receive Lasix without problems. Of course, before changing your practice, consult your medical direction.

DaSharkie
02-08-2006, 05:23 PM
Ya know, I do not believe that there is an issue. Sulfa is different than sulfate. Sulfa is a base or a group that is molecularly attached to the molecule whereas a sulfate group is striclty a sulphur atom with 4 oxygen atoms bonded to it, and collectively attached to the molecule.

It should not be an issue, as it does usually matter with antibiotics.

I know it has popped up in discussion regarding Lasix, but if I recall correctly it is a very distant possibility regarding a far removed relation to cross-reactivity with sulfa and Lasix.

mitllesmertz1
02-08-2006, 06:09 PM
tiredoldman had a great answer- it's a different compund entirely, chemically speaking.
The body shouldn't react to the SO4.

Without being a chemist, I learned in school waaay back when that there are 2 groups of sulfonamides, which in theory are the "sulfa drugs".
However, it appears that only the anti-biotic drugs (ie Silvadene,Bactrim,Septra) are the ones that cause a reaction. The other sulfonamides (ie feurosemide, Glyburide) don't cause the reaction.
I don't remember why, I just remembered the different "bad" ones :)

I have given Morphine Sulfate to many pts with sulfa allergies without problems.

And, when all else fails, call the doc!


Hope that helps!

Ridryder911
02-08-2006, 09:36 PM
Sorry, mitllesmertz1; it' spelled Furosemide not feurosemide.. you see we all make typo's... I agree with you though, very little report of reaction to Morphine Sulfate has been reported to those history reactions.

Some might recommend an H2 blocker to accompany if there is a worry.

p.s. mitllesmertz1; I am not female, and I have a degree in Fire Science and worked in Rescue for over 12 years. I am defintely not against Fire Services.

R/R 911

wag11c
02-09-2006, 09:05 AM
Thanks for the answers, it basically confirms what I've already found but reiterates it. Wag

vfddoc
02-09-2006, 11:21 AM
One more thing to add...

Be aware that allergy (Type I hypersensitivity) to sulfonamides is not necessarily the same entity as non-allergic bronchospasm from metabisulfite preservatives.

Some folks, especially asthmatics, are super sensitive to metabisulfite preservatives, and will develop life-threatening bronchospasm when exposed to same. These agents are present in a variety of forms, such as some of the "fruit-fresh" type salad bar preservatives as well as some pharmaceuticals. A well-published situation occurred several years ago when a second company began to produce Propofol; they were concerned about the agent's ability to grow bacteria, so the second manufacturer included a metabisulfite preservative. The result- same drug, 2 manufacturers, one with the sulfite and one not. Manufacturer #1 began a campaign to convince physicians that brand #2 was terrible (imagine that) because of this sulfite problem. Mfr #2 countered by labeling its product as containing a sulfite and educating users on the sulfite concerns. Docs chose sides, the anti-sulfites and the sulfite is OK sides. It actually got pretty heated. I came out on the side that sulfites are OK when used wisely. Mass mayhem and widespread death and destruction was predicted by the anti-sulfites. Now, several years later, it seems that the problems have not been as common as predicted. I personally think that the problem of sulfite sensitivity is not as widespread as was thought, but I think that we must also consider the fact that the fracas brought such sensitivity to the table of discussion. Perhaps we aren't seeing problems because we're asking about metabisulfite sensitivity, especially in asthmatics.

In a nutshell- I still use agents with metabisulfite preservatives, but I DO ask about sensitivity, especially in patients with asthma or a previous history of wheezing. It is definitely a different entity than sulfonamide allergy.

You guys (& girl(s)) thought I wasn't listening, didn't you?

Doc

DaSharkie
02-09-2006, 01:40 PM
You guys (& girl(s)) thought I wasn't listening, didn't you?

Not me. I compare you a sniper (a Marine sniper of course ;) ) lurking out in the bush, assessing the appropriate target and waiting for the appropriate opportunity to pounce.

Dammit, I just wish you would pounce more for crying out loud and quit holding all that knowledge in your Brain Housing Group. I only have 6 months before I am out on my own and need all the knowledge you can send my way.

No pimping though. I get enough of that already. :D