title: Management of Hypersensitivity Reactions to Proton Pump Inhibitors: A Retrospective Experience.
abstract: 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.
authors.affiliation: Division of Allergy and Immunology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Seçil
authors.initials: S
authors.lastname: Kepil Özdemir
authors.forename: Ferda
authors.initials: F
authors.lastname: Öner Erkekol
authors.forename: Derya
authors.initials: D
authors.lastname: Ünal
authors.forename: Suna
authors.initials: S
authors.lastname: Büyüköztürk
authors.forename: Aslı
authors.initials: A
authors.lastname: Gelincik
authors.forename: Adile Berna
authors.initials: AB
authors.lastname: Dursun
authors.forename: Gül
authors.initials: G
authors.lastname: Karakaya
authors.forename: Sevim
authors.initials: S
authors.lastname: Bavbek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003429:Cross Reactions / Q000276:immunology; D019468:Disease Management; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012882:Skin Tests; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors