Sulfa, Sulfite, Sulfate, and Sulfur: True Allergy, Cross Allergy, or No Allergy (2023)

Escrito por: John K. Chen, PhD, PharmD, OMD, LAc

Reviewed by Tina T. Chen, LAc, Donna Chow Sanchez, LAc; ANDAnita Chen Marshall, DAOM, PharmD, PhD, LAc

introduction

Sulfa, sulfite, sulfate and sulfur are four terms that sound similar but have very different allergy profiles. As a healthcare professional, it is important to understand these four terms to determine whether patients have a true allergy, a cross allergy, or no drug, herb, or food allergy.

1. Sulfa (sulfonamide and non-sulfonamide antibiotics)

"Sulfa drugs" mainly refers to sulfonamide antimicrobial agents such as sulfamethoxazole, sulfisoxazole, sulfafurazole and sulfadiazine, which contain sulfur, oxygen, nitrogen and other groups. Allergic reactions occur due to the action of antimicrobial sulfonamides, not the sulfur itself. Although 3-4% of patients report being allergic to sulfonamides, only 3% of these patients have a true allergy to antimicrobial sulfonamides.^[1],[2],[3]True hypersensitivity reactions, such as rashes and hives, usually resolve within two weeks of stopping the drug. Severe hypersensitivity reactions such as blistering and mucosal reactions may require hospitalization.^[4],[5],[6]

Non-antimicrobial sulfonamides include drugs such as furosemide, hydrochlorothiazide, acetazolamide, sulfonylureas, and celecoxib. Sulfonamide antibiotics and non-sulfonamide antibiotics have different chemical structures and there is no clinical evidence of cross-allergy.^[7],[8]

Sulfonamides were originally derived from the red dye. There is no data available to determine whether there is a cross-allergy to Chinese herbs used as a blue/green dye such asbanishment LAN Generation(Radix isatidis),Y Qing SM(Isatidis leaf) andQing Marking(natural indigo).

2. Sulfitos

Sulfites are molecules containing a sulfur atom surrounded by 2 or 3 oxygen atoms. Sulfites naturally occur in some foods during the fermentation process, e.g. B. in red wine. Sulphites, which can be added as a preservative to prevent food from discoloring and spoiling due to bacteria, are common in foods such as dried fruit (except dark raisins and prunes), bottled lemon juice (not frozen), bottled lemon juice ( not frozen) contain . , sauerkraut (and its juice), grape juice (white, sparkling white, sparkling pink, sparkling red), salad, and pickled cocktail onions.

Sulfites are also found in many oral medications.(adrenaline, isoprenaline, isoproterenol, isoetharine, phenylephrine, dexamethasone and injectable corticosteroids, dopamine, local anesthetics, propofol, aminoglycoside antibiotics, metoclopramide and doxycycline), and topical creams and ointments (antifungals and corticosteroids). Finally, many cosmetic products also contain sulfites (hair dyes and bleaches, permanent home solutions, skin lighteners/bleachers, tanning lotions, anti-aging creams and moisturizers, facial cleansers, eye creams, body soaps/cleanses, sprays , perfumes, blushes, bronzers and illuminators).^[9]

Sulfites exist in many forms, including bisulfite, metabisulphite and sulfur dioxide. Sulfites trigger allergies in about 1% of the population. Hypersensitivity reactions include urticaria, dyspnoea and, in severe cases, anaphylactic shock. The US FDA requires that products containing more than 10 ppm of sulfite be labeled on the label.^[10]

Sulfites and sulfonamides have different chemical structures and there is no evidence of cross-allergy between sulfites and sulfonamides.^[11],[12]

Advice should be given to patients with a sulfite allergy to ensure that the seven herbs listed below are sulfite-free. Chinese herbs that can be treated with sulfite include:Bai Guo(Samen-Ginkgo),Bai AND(lily bulb),ge Generation(Root of Pueraria Lobata),Gou qi Marking(lychee fruit),Ren Shen(Radix e Rhizoma Ginseng),Shan Yao(Rizoma Dioscoreae),Sim Zhu(Rizoma Polygonati Odorati).

3. Sulfate

Sulfates contain a sulfur atom surrounded by 4 oxygen atoms. Sulfates are widely used in everyday life: medications containing sulfate (e.g. ferrous sulphate), dietary supplements (e.g. glucosamine sulphate) and personal care products (e.g. shampoo, toothpaste, foam, shaving cream, liquid soap and facial cleanser).^[13]

Sulfate allergies are rare. Again, sulfates are different from antimicrobial sulfonamides and sulfites and do not cause allergic or sensitivity reactions.

4. Sulfur

Sulfur is a chemical that is naturally present in many amino acids and other important molecules in the body. In fact, it is the third most abundant mineral in the human body after calcium and phosphorus. Sulfur is also found in many foods such as garlic, onions and broccoli.^[14]

While some people may be allergic to the antimicrobial effects of sulfonamides and sulfites, this is not the case.Tyou have a true allergy to sulfur itself. A true sulfur allergy is virtually impossible, as sulfur is present in all living tissue and humans cannot survive without it.

Diploma

Sulfa, sulfite, sulfate and sulfur are four terms that sound similar but have very different clinical implications. In addition to asking about patients' allergy profiles, healthcare professionals should help patients understand the differences between these four terms so that patients with true or cross-allergy to sulfonamides, sulfites and/or sulfates, these drugs, herbs , food and products

• Sulfonamides, particularly antimicrobial sulfonamides, can cause allergies in about 3% of the population. There is no clinical evidence of cross-allergy between sulfonamide antimicrobials and non-sulfonamide antimicrobials, and no documented evidence of cross-allergy between sulfonamide antimicrobials and Chinese herbs.
• Sulfites, including bisulfite, metabisulfite and sulfur dioxide, are widely used in foods, dietary supplements, pharmaceuticals and cosmetics. There is no evidence of cross-allergy between antimicrobial sulfonamides and sulfites. In patients with true sulfite allergy, seven herbs (listed above) should be tested to ensure they do not contain sulfites.
• Sulfates are widely used in everyday life as medicines, dietary supplements and personal care products. Sulfate allergies are rare. There is no evidence of cross-allergy between sulfates with antimicrobial sulfonamides and sulfites.
• Sulfur is a chemical that occurs naturally in the human body and in many foods. A sulfur allergy is virtually impossible.

About the author

Dr John K. Chen, PhD, PharmD, OMD, LAc, is lead author ofChinese medicinal herbalism and pharmacology(2003, Art of Medicine Press) eChinese herbal formulas and uses(2008, Art of Medicine Press).

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