title: Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Chest Diseases, Division of Allergy and Immunology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kepil Özdemir
authors.forename: I
authors.initials: I
authors.lastname: Yılmaz
authors.forename: Ö
authors.initials: Ö
authors.lastname: Aydin
authors.forename: S
authors.initials: S
authors.lastname: Büyüköztürk
authors.forename: A
authors.initials: A
authors.lastname: Gelincik
authors.forename: M
authors.initials: M
authors.lastname: Demirtürk
authors.forename: D
authors.initials: D
authors.lastname: Erdoğdu
authors.forename: S
authors.initials: S
authors.lastname: Cömert
authors.forename: T
authors.initials: T
authors.lastname: Erdoğan
authors.forename: G
authors.initials: G
authors.lastname: Karakaya
authors.forename: A F
authors.initials: AF
authors.lastname: Kalyoncu
authors.forename: F
authors.initials: F
authors.lastname: Oner Erkekol
authors.forename: A B
authors.initials: AB
authors.lastname: Dursun
authors.forename: Z
authors.initials: Z
authors.lastname: Misirligil
authors.forename: S
authors.initials: S
authors.lastname: Bavbek
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003429:Cross Reactions / Q000276:immunology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D016037:Single-Blind Method; D012882:Skin Tests / Q000379:methods*; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole
keywords: cross-reactivity; drug allergy; hypersensitivity; proton pump inhibitors; skin tests