Anaphylaxis to proton pump inhibitors

Abstract

Proton pump inhibitors (PPI) are widely used for the treatment of peptic ulcer, but cases of anaphylactic reactions have rarely been described. We present a patient who experienced an episode of urticaria 30 minutes after oral intake of an omeprazole capsule. Skin prick tests to omeprazole, pantoprazole and lansoprazole were positive. Challenge test with lansoprazole was carried out and within 45 minutes the patient developed urticaria, facial edema, vomiting, and hypotension. Oral challenge with other imidazole derivatives (ketoconazole, cimetidine, metronidazole) were carried out with good tolerance. Serum tryptase levels determined 3 hours after the adverse reaction to lansoprazole were elevated. Specific IgE to PPI were not detected by an enzyme-linked immunosorbent assay technique. The clinical findings, positive skin prick test to PPI and elevated serum tryptase levels suggest that an IgE-mediated mechanism was implicated in the reactions to both omeprazole and lansoprazole. Skin prick tests may be a useful tool for detecting patients sensitized to PPI. An experimental protocol was used to detect specific IgE antibodies against PPI, which may explain RAST negativity. The previous findings suggest that cross-reactivity between PPI exists, but not with other imidazoles.

Tryptamine-Gallic Acid Hybrid Prevents Non-steroidal Anti-inflammatory Drug-induced Gastropathy

“…(5). Although proton pump inhibitors are effective at a very low dose against NSAID-induced gastropathy (5), they have some adverse effects like diarrhea (57), linear mucosal defects, and friable mucosa associated with collagenous colitis (58,59), subacute cutaneous lupus erythematosus (60), Leydig cell tumors (61), acute nephritis (62), myopathy including polymyositis (63), and anaphylactic reactions (64). Proton pump inhibitors are reported to be associated with an increased risk of bacterial infection and related diseases (65,66).…”

Management of Hypersensitivity Reactions to Proton Pump Inhibitors: A Retrospective Experience

“…In the study by Bonadonna et al [13], 4/12 patients who exhibited positive skin tests with the suspected PPI underwent an OPT, and the result was positive in all cases. Additionally, there are case reports showing confirmation of skin test positivity with oral challenge tests with PPIs [1,2,3,6]. Based on these data, we did not perform confirmatory OPTs in patients with skin test positivity to the culprit or alternative PPIs.…”

“…Although hypersensitivity reactions due to PPIs are rare, several anaphylactic reactions have been reported [1,2,3,4,5,6,7,8,9,10,11,12,13,14]. The frequency of life-threatening reactions due to immediate hypersensitivity to PPIs and the common usage of these drugs make PPI hypersensitivity a significant problem.…”

“…We previously reported perfect specificity and low sensitivity of skin tests in PPI-induced immediate hypersensitivity reactions in a prospective, multicenter study [12]. Previous trials and case reports suggested variable cross-reactivity patterns among PPIs [1,6,7,12,13,15]. In this retrospective, multicenter study, we aimed to evaluate the diagnostic workup procedures and characteristics of patients with suspected PPI hypersensitivity.…”

Antiulcer Activity of the Methanolic Extract of Sesbania Graindiflora

“…To regain the balance, different therapeutic agents including plant extracts are used to inhibit the gastric acid secretion or to encourage the mucosal defense mechanisms by increasing mucus production, stabilizing the surface epithelial cells, or interfering with the prostaglandin synthesis. Even though many products in the market for the treatment of gastric ulcers, including antacids, proton pump inhibitors, anticholinergics and histamine H2-antagonists, are used, most of these drugs produce several adverse reactions, such as gynecomastia, hematopoietic changes, acute interstitial nephritis [19] , thrombocytopenia [20] , anaphylaxis reactions [21] , nephrotoxicity and hepatotoxicity [22] . Medicinal plants are amongst the most attractive sources of new drugs, and have been shown to give promising results in treatment of gastric and duodenal ulcers.…”