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True allergic responses to drugs occur in 5% of the population and in up to 30% of HIV infected patients.1 Patients often describe any adverse drug reaction as an allergy, and sulfonamide or “sulfa” allergy is one of the most commonly reported allergies. Sulfonamide is a chemical structure contained in many groups of medications, including antibiotics, diuretics, and nonsteroidal anti-inflammatory drugs.1 Allergic or hypersensitivity reactions to sulfonamide medications can cause multiple symptoms and/or syndromes; the most common presentation is either a generalized maculopapular rash or a fixed drug eruption. The mechanisms include both immune and nonimmune reactions. 1 Common nonimmune reactions include drug intolerances, idiosyncratic reactions, and toxic reactions. In general the presence of fever implies a more severe reaction.1

Sulfa Allergy and Therapeutic Decisions