Approach to managing patients with sulfa allergy: use of antibiotic and nonantibiotic sulfonamides.

Dear Dr. Ponka:

Thank you for your 11-10-06 article. Quite informative as a sulfa intolerant patient (suspected vestibular migraine or meniere's or combination thereof sufferer). I ended up discovering my sulfa intolerance after having quite a severe reaction to acetazolamide/diamox back in 2002 (and also finding out that my mother has a sulfa intolerance).

A couple of points that may interest you:

(a) Ethacrynic acid and amiloride are totally sulfa-free. Unfortunately, Ethacrynic acid is no longer available in the U.S. but may still be available in Canada and Australia.

(b) Triamterene has no sulfa in the structure, but it has laureth sulfate incorporated in the pill. This may not be a good choice for sulfa intolerant patients in pill form (I tried it and after 28 or so days had an adverse reaction). Maybe the manufacturer can be persuaded to change the pill form or manufacture a capsule.

Inspra, a relatively new diuretic, also may have laureth sulfate incorporated in the pill, although there is no sulfa in the structure (see http://www.fda.gov/cder/foi/label/2002/21437lbl.pdf).

(c) Spironolactone, despite the literature, actually has sulfur in the structure (look at its chemical makeup), and may not be the best choice for truly sulfa intolerant patients.

(d) As a non-physician, it has been extraordinarily frustrating to get help or accurate information in this area, although your article was one of the best.

I think an area that may be of benefit is to find out more about desensitizing protocols or qualified physicians who can take on this challenge. Many MDs just throw up their hands and say there is nothing that they can do. Your article demonstrates that that simply is not the case.