Management of hypersensitivity reactions to proton pump inhibitors: A retrospective experience
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2016Author
Özdemir, Seçil KepilErkekol, Ferda Öner
Ünal, Derya
Büyüköztürk, Suna
Gelincik, Aslı
Dursun, Adile Berna
Karakaya, Gül
Bavbek, Sevim
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Kepil Özdemir, S., Öner Erkekol, F., Ünal, D., Büyüköztürk, S., Gelincik, A., Dursun, A. B., Karakaya, G., & Bavbek, S. (2016). Management of Hypersensitivity Reactions to Proton Pump Inhibitors: A Retrospective Experience. International archives of allergy and immunology, 171(1), 54–60. https://doi.org/10.1159/000450952Abstract
Background: We previously reported perfect specificity and low sensitivity of skin tests in proton pump inhibitor (PPI)-induced immediate hypersensitivity reactions in a prospective multicenter study. Here, in a retrospective study, we aimed to further evaluate the diagnostic workup procedures and characteristics of the patients with suspected PPI hypersensitivity. Methods: This national multicenter study was conducted as a retrospective chart review of patients with a history of PPI-induced immediate hypersensitivity reaction. A total of 60 patients were included. Results of diagnostic workup procedures (standardized skin-prick, intradermal, and oral-provocation tests with PPIs) and the characteristics of the patients were analyzed. Results: Lansopra-zole was the most commonly suspected drug with 41 patients (68.3%), followed by pantoprazole in 12 patients (20.0%), esomeprazole in 6 (10.0%), rabeprazole in 4 (6.7%), and omeprazole in 1 (1.7%). Anaphylaxis (40 patients, 66.7%) was the most common clinical presentation followed by urticaria (17 patients, 28.3%). Diagnostic skin tests with the culprit PPI were positive in 13/26 patients (50.0%). Diagnostic oral-provocation tests were negative in 6/8 patients; 5 of these 6 patients had skin test results with the culprit PPI, and all were negative. Ten patients had at least 1 cross-reactivity. Extensive cross-reactivity (between > 2 PPIs) was detected in 4 patients. Conclusions: Lansoprazole was the most frequently implicated drug and anaphylaxis was the most frequent manifestation of PPI-induced hypersensitivity reactions. Physicians should be aware of the possible crossreactivity among PPIs; however, a safe, alternative PPI can usually be detected by a thorough drug allergy workup. (C) 2016 S. Karger AG, Basel