Non Immediate-type Hypersensitivity Reactions to Proton Pump Inhibitors

Case Report

Austin J Allergy. 2014;1(2): 2.

Non Immediate-type Hypersensitivity Reactions to Proton Pump Inhibitors

Giuliana Zisa1*, Luisa Bommarito1, Francesca Riccobono1, Joseph Scibilia2 and Maurizio Galimberti3

1Allergology and Immunology Unit, Novara Hospital, Italy

2Allergy and Immunology, Ospedale Niguarda, Milan, Italy

3Allergy consultant Fleming Research, Novara, Italy

*Corresponding author: Giuliana Zisa, Allergology and Immunology Unit, Novara Hospital, Italy.

Received: July 28, 2014; Accepted: August 16, 2014; Published: August 18, 2014

Keywords

Hypersensitivity; Proton pump inhibitors; Skin tests

Proton pump inhibitors (PPIs), commonly used for gastrointestinal diseases, are associated with a low incidence of adverse reactions [1-5].

We present two patients with non immediate reactions to such drugs diagnosed in our allergy clinic during 2011 to 2012.

Written informed consent was obtained from each patient before the performance of skin and provocation tests. Cutaneous sensitivity to esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole was evaluated by skin tests (prick and intradermal tests) for esomeprazole, omeprazole and pantoprazole at a concentration of 40 mg/ml, for rabeprazole 20 mg/ml, lansoprazole 15 mg/ml (at 1:1 for prick test and at 1:1000, 1:100 and 1:10 dilutions for intradermal tests). Histamine and saline were used as positive and negative controls, respectively. Skin tests with tested drugs were negative in five control subjects. A safe alternative drug was found for both patients after a negative single-blind, placebo-controlled oral provocation test with a proton pump inhibitor that displayed negative results in skin tests.

Oral provocation test started with a single dose of talc as placebo and then increasing doses (one-quarter and three-quarter of a therapeutic dose) of PPI in identical opaque capsules were given at 1-hour intervals. Patients were kept under observation for 2 hours after the last provocation dose.

Characteristics of reactions and results of skin tests and provocation test are described in table 1.

Citation: Zisa G, Bommarito L, Riccobono F, Scibilia J and Galimberti M. Non Immediate-type Hypersensitivity Reactions to Proton Pump Inhibitors. Austin J Allergy. 2014;1(2): 2. ISSN:2378-6655