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Bavbek S, Kepil Özdemir S, Bonadonna P, Atanaskovic-Markovic M, Barbaud A, Brockow K, Laguna Martinez J, Nakonechna A, Pagani M, Arcolacı A, Lombardo C, Torres MJ. Hypersensitivity reactions to proton pump inhibitors. An EAACI position paper. Allergy 2024; 79:552-564. [PMID: 38013608 DOI: 10.1111/all.15961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
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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Affiliation(s)
- Sevim Bavbek
- Division of Immunology and Allergy, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Seçil Kepil Özdemir
- Department of Chest Diseases, Allergy and Immunology Unit, İzmir Faculty of Medicine, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | | | - Marina Atanaskovic-Markovic
- Department of Allergology and Pulmonology, Faculty of Medicine, University of Belgrade, University Children's Hospital, Belgrade, Serbia
| | - Annick Barbaud
- Département de dermatologie et allergologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Jose Laguna Martinez
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain
| | - Alla Nakonechna
- Allergy and Clinical Immunology Department, University of Liverpool, Royal Preston Hospital, Lancashire Teaching Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Mauro Pagani
- Medicine Department, Medicine Ward Mantova Hospital, ASST di Mantova, Mantova, Italy
| | | | - Carla Lombardo
- Division of Dermatology and Allergy, APSS - Trento Hospital, Trento, Italy
| | - Maria J Torres
- Allergy Unit, Regional University Hospital of Malaga, IBIMA-UMA-ARADyAL, Malaga, Spain
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Casciaro M, Navarra M, Inferrera G, Liotta M, Gangemi S, Minciullo PL. PPI adverse drugs reactions: a retrospective study. Clin Mol Allergy 2019; 17:1. [PMID: 30675130 PMCID: PMC6337765 DOI: 10.1186/s12948-019-0104-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022] Open
Abstract
Proton pump inhibitors (PPIs) are drugs capable of blocking the gastric pump H,K-ATPase in order to inhibit gastric acid secretion. Omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole belong to PPIs category. Although PPIs have a good safety profile, allergic reactions to these molecules can occur. The real rate of hypersensitive reactions to PPIs is unknown. The aim of this retrospective study is to evaluate the rate of hypersensitive reactions to PPIs in patients admitted to our Unit between 2008 and 2013 with a history of drug hypersensitivity. From a database of 1229 patients (921 women, 308 men) with adverse drug reaction we extrapolated the data about PPI reactions. Twelve patients (10 female, 2 men) had a positive history for hypersensitive reaction to PPI. Pantoprazole was the most frequently PPI involved. Based on patient personal history in some cases we performed an oral challenge test for an alternative anti-acid drug and none of them had adverse reactions. According to our experience and according to the literature and pharmacovigilance reports, ADR caused by PPIs are ever increasing. Adverse reactions to these drugs are still under-reported; however, considering the frequency of their prescription worldwide, the risk of severe allergic events is low. Further studies are needed to provide clearer data on the real incidence and prevalence about this matter. This should be useful to help physician in choosing the molecule to prescribe and, in case of hypersensitivity, the alternative molecule to test, also considering the possible cross-reactivity.
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Affiliation(s)
- Marco Casciaro
- 1School and Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Navarra
- 2Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | | | - Marta Liotta
- 1School and Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- 1School and Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paola Lucia Minciullo
- 1School and Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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The Basophil Activation Test Can Be of Value for Diagnosing Immediate Allergic Reactions to Omeprazole. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1628-1636.e2. [DOI: 10.1016/j.jaip.2017.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/13/2017] [Accepted: 12/06/2017] [Indexed: 01/15/2023]
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Benito-Garcia F, Chambel M, Morais-Almeida M. Anaphylaxis due to proton pump inhibitors: current understanding and important clinical considerations. Expert Rev Clin Immunol 2018; 14:653-656. [DOI: 10.1080/1744666x.2018.1505504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Marta Chambel
- Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
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Rare drug allergies: Review on prevalence and test procedures. Allergol Select 2017; 1:160-168. [PMID: 30402614 PMCID: PMC6040010 DOI: 10.5414/alx01578e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/14/2013] [Indexed: 12/13/2022] Open
Abstract
This paper gives a review on rare hypersensitivity reactions (including allergies) to drugs. Pathogenesis, allergy tests and possible therapeutic options are discussed by presenting examples out of the following group of drugs: antiinfectious (i.e. chinolones, telaprevir), oncological (i.e. platin-based cytostatics), immunologic (i.e. cetuximab, omalizumab), others (i.e. glucocorticosteroids). Usually there is no standardized allergologcial work-up procedure. Testing must therefore take into consideration previous experiences from other authors and on general recommendations.
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Kepil Özdemir S, Öner Erkekol F, Ünal D, Büyüköztürk S, Gelincik A, Dursun AB, Karakaya G, Bavbek S. Management of Hypersensitivity Reactions to Proton Pump Inhibitors: A Retrospective Experience. Int Arch Allergy Immunol 2016; 171:54-60. [DOI: 10.1159/000450952] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022] Open
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Otani IM, Banerji A. Immediate and Delayed Hypersensitivity Reactions to Proton Pump Inhibitors: Evaluation and Management. Curr Allergy Asthma Rep 2016; 16:17. [PMID: 26810177 DOI: 10.1007/s11882-016-0595-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PPIs are among the most commonly administered medications in the USA and are generally well tolerated. Immediate and delayed immune-mediated hypersensitivity reactions are rare but increasingly recognized adverse effects of proton pump inhibitors (PPIs). Immediate hypersensitivity reactions can occur due to IgE-mediated hypersensitivity to PPIs and can be evaluated by immediate hypersensitivity skin testing and oral provocation challenge testing. A desensitization protocol can be used when PPI use cannot be avoided in an allergic patient. Delayed hypersensitivity reactions to PPIs have also been reported. Occupational exposures causing cutaneous reactions to PPIs are the most commonly reported delayed hypersensitivity reaction, followed by drug-induced subacute cutaneous lupus erythematosus. This review presents a summary of the clinical presentation, diagnostic evaluation, and management of immune-mediated hypersensitivity reactions to PPIs.
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Affiliation(s)
- Iris M Otani
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
| | - Aleena Banerji
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
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Lombardo C, Bonadonna P. Hypersensitivity Reactions to Proton Pump Inhibitors. CURRENT TREATMENT OPTIONS IN ALLERGY 2015. [DOI: 10.1007/s40521-015-0046-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hammami S, Affes H, Ksouda K, Feki M, Sahnoun Z, Zeghal KM. Étude de l’allergie croisée entre les différents inhibiteurs de la pompe à protons. Therapie 2013; 68:361-8. [DOI: 10.2515/therapie/2013061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/21/2013] [Indexed: 01/19/2023]
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Evaluation and management of hypersensitivity to proton pump inhibitors. Ann Allergy Asthma Immunol 2013; 111:452-7. [PMID: 24267357 DOI: 10.1016/j.anai.2013.08.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/20/2013] [Accepted: 08/22/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Proton pump inhibitors (PPIs) are widely used for the treatment of gastroesophageal reflux disease and peptic ulcer disease. PPIs are well tolerated, but they can cause hypersensitivity reactions (HSRs). Although simply avoiding a PPI after an HSR is appropriate for most patients, there are clinical scenarios that require treatment with a PPI. DATA SOURCES A comprehensive literature review was performed to propose an evidence-based approach to the evaluation and management of HSRs to PPIs. STUDY SELECTIONS Articles from June 1986 through September 2012 on PPI hypersensitivity were reviewed. Thirty-nine studies that met the search criteria were included in the review. HSRs to PPIs and skin testing protocols used to evaluate HSRs were analyzed from the 39 identified publications. For each case, the culprit drug and dose, the age and sex of the patient, and the symptoms and timing of the HSR were recorded. HSRs were classified into immune- or nonimmune-mediated categories. RESULTS A total of 118 cases of immune-mediated HSRs to 5 PPIs were identified, most of which were suspected IgE-mediated HSRs. Omeprazole was the culprit PPI most frequently associated with HSRs. The most common clinical manifestations of PPI HSRs were cutaneous reactions. Nonirritating concentrations for skin prick and intradermal testing were identified. Skin testing showed variable cross-reactivity patterns among the different PPIs. CONCLUSION The HSRs to PPIs should be formally investigated, especially when reasonable alternative therapies do not exist. The reviewers propose an evidence-based algorithm for evaluating and managing patients with an HSR to a PPI.
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Kepil Özdemir S, Yılmaz İ, Aydın Ö, Büyüköztürk S, Gelincik A, Demirtürk M, Erdoğdu D, Cömert Ş, Erdoğan T, Karakaya G, Kalyoncu AF, Öner Erkekol F, Dursun AB, Mısırlıgil Z, Bavbek S. Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity. Allergy 2013; 68:1008-14. [PMID: 23895584 DOI: 10.1111/all.12189] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data are limited about the value of skin tests in the diagnosis of proton pump inhibitor (PPI)-induced hypersensitivity reactions and the cross-reactivity between PPIs. We aimed to assess the role of skin testing in the diagnosis of PPI-related immediate hypersensitivity reactions and the cross-reactivity patterns among PPIs. METHODS The study was designed in a prospective, national, multicentre nature. Sixty-five patients with a suggestive history of a PPI-induced immediate hypersensitivity reaction and 30 control subjects were included. Standardized skin prick and intradermal tests were carried out with a panel of PPIs. Single-blind, placebo-controlled oral provocation tests (OPTs) with the PPIs other than the culprit PPI that displayed negative results in skin tests (n = 61) and diagnostic OPTs with the suspected PPI (n = 12) were performed. RESULTS The suspected PPIs were lansoprazole (n = 52), esomeprazole (n = 11), pantoprazole (n = 9), rabeprazole (n = 2), and omeprazole (n = 1). The sensitivity, specificity, and negative and positive predictive values of the skin tests with PPIs were 58.8%, 100%, 70.8%, and 100%, respectively. Fifteen of the 31 patients with a hypersensitivity reaction to lansoprazole had a positive OPT or skin test result with at least one of the alternative PPIs (8/52 pantoprazole, 6/52 omeprazole, 5/52 esomeprazole, 3/52 rabeprazole). CONCLUSION 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.
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Affiliation(s)
- S. Kepil Özdemir
- Department of Chest Diseases; Division of Allergy and Immunology; Ankara University School of Medicine; Ankara; Turkey
| | - İ. Yılmaz
- Department of Chest Diseases; Division of Allergy and Immunology; Ankara University School of Medicine; Ankara; Turkey
| | - Ö. Aydın
- Department of Chest Diseases; Division of Allergy and Immunology; Ankara University School of Medicine; Ankara; Turkey
| | - S. Büyüköztürk
- İstanbul Faculty of Medicine; Department of Internal Medicine; Division of Allergy and Immunology; İstanbul University; İstanbul; Turkey
| | - A. Gelincik
- İstanbul Faculty of Medicine; Department of Internal Medicine; Division of Allergy and Immunology; İstanbul University; İstanbul; Turkey
| | - M. Demirtürk
- İstanbul Faculty of Medicine; Department of Internal Medicine; Division of Allergy and Immunology; İstanbul University; İstanbul; Turkey
| | - D. Erdoğdu
- İstanbul Faculty of Medicine; Department of Internal Medicine; Division of Allergy and Immunology; İstanbul University; İstanbul; Turkey
| | - Ş. Cömert
- Department of Chest Diseases; Division of Allergy and Immunology; Hacettepe University School of Medicine; Ankara; Turkey
| | - T. Erdoğan
- Department of Chest Diseases; Division of Allergy and Immunology; Hacettepe University School of Medicine; Ankara; Turkey
| | - G. Karakaya
- Department of Chest Diseases; Division of Allergy and Immunology; Hacettepe University School of Medicine; Ankara; Turkey
| | - A. F. Kalyoncu
- Department of Chest Diseases; Division of Allergy and Immunology; Hacettepe University School of Medicine; Ankara; Turkey
| | - F. Öner Erkekol
- Department of Chest Diseases; Division of Allergy and Immunology; Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital; Ankara; Turkey
| | - A. B. Dursun
- Department of Chest Diseases; Division of Allergy and Immunology; Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital; Ankara; Turkey
| | - Z. Mısırlıgil
- Department of Chest Diseases; Division of Allergy and Immunology; Ankara University School of Medicine; Ankara; Turkey
| | - S. Bavbek
- Department of Chest Diseases; Division of Allergy and Immunology; Ankara University School of Medicine; Ankara; Turkey
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Aksu K, Kurt E. Anaphylaxis to lansoprazole with tolerance to omeprazole. Allergol Immunopathol (Madr) 2012; 40:393-4. [PMID: 22115571 DOI: 10.1016/j.aller.2011.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/11/2011] [Accepted: 09/14/2011] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Proton pump inhibitors (PPI) are one of most frequently prescribed drugs in the world. The purpose of this review is to describe the hypersensitivity reactions to PPI. RECENT FINDINGS Hypersensitivity reactions to PPI vary from mild symptoms to life-threatening disorders. Cases of urticaria, angioedema, anaphylaxis, cytopenia, vasculitis, acute allergic interstitial nephritis, occupational contact dermatitis, photoallergic dermatitis, maculopapular eruption, erythroderma, Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, Stevens-Johnson syndrome/toxic epidermal necrolysis, and other autoimmune reactions (including cutaneous lupus erythematosus) have been described. SUMMARY A high level of clinical suspicion is critical in the diagnosis of PPI-induced hypersensitivity reactions. Physicians should be aware of the possible hypersensitivity reactions due to PPI and routine/empirical prescription for PPI should only be used when clinically indicated.
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Soubeiran E, Müller S, Jakob T. Soforttypallergie auf Omeprazol mit systemischer Reaktion nach Hauttestung. ALLERGO JOURNAL 2012. [DOI: 10.1007/s15007-012-0126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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