Furosemide


Furosemide or chloro-4-furfurylamino-2-sulfamoyl-5-benzoic acid is a widely used Henle’s loop diuretic.
 
Incidence
Exceedingly rare for anaphylactic reactions.
 
0.5% for mild cutaneous reactions.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: pruritus, urticaria, periorbital edema, eczematous rash, vasculitis, lichenoid eruption, vesiculo-bullous eruption, Stevens Johnson’s syndrome.
 
Respiratory: acute pulmonary edema.
 
Digestive: pancreatitis, hepatitis.
 
Diagnostic methods
Cutaneous testing.
 
Prick-tests: negative;
 
Intradermal at 1%: positive for furosemide as well as for chlorothiazide, bumetanide and sulfamethoxazoletrimethoprim.
 
One case with delayed positivity (10th hour).
 
Mechanisms
Type I suspected on a basis of immediate positive skin tests.
 
Type III suspected in pancreatitis and hepatitis.
 
Management
Avoidance.
 
No cross reactivity between furosemide and sulfonamides.
 
Bumetanide may be used as replacement therapy in furosemide induced vasculitis.

References

  1. Gratadour P, Guillaume C, Bui-Xuan B, Godard J, Vedrinne J.M, Motin J, "Absence d’allergie croisée entre furosemide et bumetanide", Presse. Med., 1990; 19 (32): 1504 
  2. Breuil K, Patte F, Meurice J.C, Vandel B, Pineau-Drouin D, "Allergie de mécanisme non-immediat au furosemide", Rev. fr. Allergol., 1989; 29 (3): 150-1
  3. Hansbrough J.R, Wedner H.J, Chaplin D.D, "Anaphylaxis to intravenous furosemide", J. Allergy Clin. Immunol., 1987; 80 ( 4): 538-41 
  4. Thestrup-Pedersen K, "Adverse reactions in the skin from antihypertensive drugs", Dan. Med. Bull., 1987; 34 (S1): 3-5
  5. Tuzel I.H, "Comparison of adverse reactions to bumetamide and furosemide", J. Clin. Pharmacol., 1981; 21: 615-9

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.