Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity

Özdemir, Seçil Kepil; Yılmaz, İnsu; Aydın, Ömür; Büyüköztürk, Suna; Gelincik, Aslı; Demirtürk, Mustafa; Erdoğdu, Derya; Cömert, Sevda Şener; Erdoğan, Tuba; Karakaya, Gül; Kalyoncu, Fuat; Erkekol, Ferda Öner; Dursun, Adile Berna; Mısırlıgil, Zeynep; Bavbek, Sevim

doi:10.1111/all.12189

Cited by 33 publications

(44 citation statements)

References 14 publications

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“…Diagnostic tests were performed according to the allergist's decision and the patient's consent. We used skin test concentrations proven in our previous study to be nonirritating in 30 healthy controls [12]. Skin-prick tests (SPTs) were performed with the undiluted commercial oral preparations of an omeprazole capsule (20 mg), a lansoprazole capsule (30 mg), a pantoprazole tablet (40 mg), a rabeprazole tablet (20 mg), and an esomeprazole tablet (20 mg) by the prick method and 1/10 and 1/1 dilutions of injectable preparations of omeprazole (4 mg/mL), pantoprazole (4 mg/mL), and esomeprazole (8 mg/mL), along with positive (histamine 0.01%) and negative (saline 0.9%) controls.…”

Section: Methodsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…Skin tests are useful in the diagnosis of immediate reactions to PPIs [12,13]. We previously reported perfect specificity and low sensitivity of skin tests in PPI-induced immediate hypersensitivity reactions in a prospective, multicenter study [12].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Özdemir

Erkekol²,

Ünal³

et al. 2016

Int Arch Allergy Immunol

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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: Lansoprazole 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 cross-reactivity among PPIs; however, a safe, alternative PPI can usually be detected by a thorough drug allergy workup.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Özdemir

Erkekol²,

Ünal³

et al. 2016

Int Arch Allergy Immunol

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“…From the above pharmacovigilance report, it can be concluded that a patient population of females, more than 60 years of age, having taken the drug for less than 1 month, and having hypertension is affected most frequently by fever towards pantoprazole. Since no eosinophilia and skin reactions were observed in our patient, we did not perform a skin prick test with pantoprazole [11]. …”

Section: Discussionmentioning

confidence: 99%

Drug Fever due to a Single Dose of Pantoprazole

Schiller

Maieron²,

Schöfl³

et al. 2014

Pharmacology

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Although proton pump inhibitors (PPI) are generally well tolerated, with most adverse effects being minor and self-limiting, there are singular reports on hypersensitivity immune reactions triggered by a PPI or its metabolites. Here we report a case of acute drug-induced fever with leukocytosis and a transient increase in CRP due to pantoprazole. This was apparently an idiosyncratic reaction (inflammatory fever), showing no cross-sensitivity towards esomeprazole.

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Antiacid drugs: Proton Pump Inhibitors and H2 Receptor Antagonists

Bonadonna

Lombardo

2022

Cutaneous Drug Hypersensitivity

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Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity

Abstract: Considering the high specificity, skin testing seems to be a useful method for the diagnosis of immediate-type hypersensitivity reactions to PPIs and for the evaluation of cross-reactivity among PPIs. However, OPT should be performed in case of negativity on skin tests.

Cited by 33 publications

References 14 publications

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

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

Drug Fever due to a Single Dose of Pantoprazole

Antiacid drugs: Proton Pump Inhibitors and H2 Receptor Antagonists

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