Hypersensitivity to lansoprazole with tolerance to other proton pump inhibitors: Does cross-reactivity between proton pump inhibitors really exist?

Proton pump inhibitors I Drug allergy I Anaphylaxis I Adverse drug reaction I Drug hypersensitivity Opinion Statement Proton pump inhibitors (PPIs) are drugs widely used and usually well tolerated. However, cases of immediate or cell-mediated hypersensitivity reactions due to all PPIs, with the exception of the newest dexlansoprazole and tenatoprazole, have been described. In the case of suspected IgE-mediated reaction skin test (prick test and intradermal test) with nonirritant drug concentration published is safe and highly specific (100 %) with a PPV of 100 %. Thus, oral provocation test should be performed only in case of negative results to rule out definitely the diagnosis. In the case of possible cell-mediated hypersensitivity reaction, a delayed reading of intradermal test, at least after 24 and 48 h, and patch test should be performed, but we do not have standardized procedures so far. Cross-reactivity among all PPIs is not a dogma, in fact, three patterns of cross-reactivity have been described. Thus, in patients with ascertained allergy to a PPI, a complete evaluation (skin test and oral provocation test) of all five PPIs available helps to identify a safe alternative.

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“…& Pattern C: patients with selective sensitization to a single PPI and who tolerate other PPIs [53,76,77,79,84].…”

Section: Cross-reactivity Among Ppismentioning

confidence: 99%

Hypersensitivity Reactions to Proton Pump Inhibitors

Lombardo

Bonadonna

2015

Curr Treat Options Allergy

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“…In a recent case of anaphylaxis due to pantoprazole reported by Turedi et al [4], cross-reactivity to all other PPIs was reported. However, Karabacak et al [5] reported a case of anaphylaxis induced by lansoprazole that showed good tolerance to other PPIs including rabeprazole. Another case report by Choi SW et al described a patient who had consumed esomeprazole 20 mg/day for 1 month without any side effects before experiencing anaphylaxis to lansoprazole [6].…”

Section: Discussionmentioning

confidence: 99%

An Uncommon Cause of Anaphylaxis: Lansoprazole. What to give next?

Aydın

Bilge

Düzenli³

et al. 2018

North Clin Istanbul

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Proton pump inhibitors (PPIs) are one of the most prescribed drugs worldwide. Anaphylactic reactions of PPIs are rare; however, several cases have been reported. Here, we report a rare case of anaphylaxis that occurred immediately following lansoprazole intake. Following the successful management in the emergency department, skin prick and oral controlled challenge tests were performed to evaluate cross-reactivity. Thereafter, lansoprazole was switched to pantoprazole, which was well tolerated. Skin prick and oral controlled challenge tests can be performed for determining the cross-reactivity of PPIs to prevent adverse reactions.

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“…Several prospective studies and retrospective case series, but also a high number of single case reports, have performed single-blind placebo-controlled DPTs with PPIs. 3,[17][18][19]22,23,37,42,45,[53][54][55][56][57][58][59][60] Only exceptionally, patients were also provoked with the skin test-positive culprit PPI to confirm specificity. 3,22,56 Furthermore, DPTs have been performed to identify tolerance to alternative PPIs for any future hiring needs and to study PPI cross-reactivity.…”

Section: Provocation Testsmentioning

confidence: 99%

“…3,22,56 Furthermore, DPTs have been performed to identify tolerance to alternative PPIs for any future hiring needs and to study PPI cross-reactivity. 3,[17][18][19]22,23,37,42,45,46,53,57,58,60,61 A placebo-controlled approach has been performed in many studies, often with placebo capsules or tablets on the first day and the verum on the second day.…”

Section: Provocation Testsmentioning

confidence: 99%

“…29 Reports on cross-reactivity and/or tolerance in immediate HSRs to PPIs confirmed by skin tests and/or DPT are summarized in Table 4. Among patients with an immediate PPI HSR that has been confirmed with skin tests and/or DPTs, available studies, 3,[17][18][19][20][22][23][24][37][38][39][40][41][42][43][44][45][53][54][55][56][57][58]60,61,[63][64][65][66][67][68][69] suggest that 61.6% will show cross-reactivity to another PPI and 8.9% will show cross-reactivity to all available PPIs. However, these results may be underestimated, as most studies have investigated cross-reactivity only towards some preparations and not towards all available PPIs.…”

Section: Cross-reactivitymentioning

confidence: 99%

See 1 more Smart Citation

Hypersensitivity reactions to proton pump inhibitors. An EAACI position paper

Bavbek,

Kepil Özdemir,

Bonadonna

et al. 2023

Allergy

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Proton pump inhibitors (PPIs) are invaluable therapeutic options in a variety of dyspeptic diseases. In addition to their well‐known risk profile, PPI consumption is related to food and environmental allergies, dysbiosis, osteoporosis, as well as immediate and delayed hypersensitivity reactions (HSRs). The latter, although a rare event, around 1%–3%, due to the extraordinarily high rate of prescription and consumption of PPIs are related to a substantial risk. In this Position Paper, we provide clinicians with practical evidence‐based recommendations for the diagnosis and management of HSRs to PPIs. Furthermore, the unmet needs proposed in the document aim to stimulate more in‐depth investigations in the topic.

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Hypersensitivity to lansoprazole with tolerance to other proton pump inhibitors: Does cross-reactivity between proton pump inhibitors really exist?

Cited by 8 publications

References 5 publications

Hypersensitivity Reactions to Proton Pump Inhibitors

Hypersensitivity Reactions to Proton Pump Inhibitors

An Uncommon Cause of Anaphylaxis: Lansoprazole. What to give next?

Hypersensitivity reactions to proton pump inhibitors. An EAACI position paper

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