Abstract

CAROLINO, Fabrícia; SILVA, Diana; CASTRO, Eunice Dias de  and  CERNADAS, Josefina Rodrigues. Challenges in the diagnosis of hypersensitivity to proton-pump inhibitors. Rev Port Imunoalergologia [online]. 2016, vol.24, n.4, pp.219-225. ISSN 0871-9721.

Background: The incidence of hypersensitivity (HS) to proton-pump inhibitors (PPI) seems to be increasing. Current recommendations for skin tests with PPI are weak and based on moderate quality evidence. Aims: To review the outcomes of in vivo diagnostic procedures and to assess the cross-reactivity (CR) patterns in patients evaluated for suspected PPI HS. Methods: This is a descriptive study of patients assessed in the Drug Allergy Unit from January/2007 to December/2014 for suspected PPI HS. We reviewed the outcomes of skin prick tests (SPT) and intradermal tests (IDTs) performed with commercially available parenteral PPI formulations (omeprazole, esomeprazole e pantoprazole); oral presentations of lansoprazole and rabeprazole were also used for SPT only. Results: We evaluated 19 patients (58% females; mean age±SD 51±14 years) and the main incriminated PPI was omeprazole (68%). A total of 11 patients (5 with immediate reactions) had positive skin tests, 4 of them to more than one PPI. The 3 patients with positive SPT (cases of omeprazole anaphylaxis) had skin CR (1 to omeprazole/esomeprazole and 2 to omeprazole/pantoprazole). Two patients with positive IDT to omeprazole 4 mg/ml tolerated oral omeprazole posteriorly. Specificity of skin tests was 80% (IC95%: 44%-98%). Conclusions: Omeprazol 4 mg/ml may be an irritative concentration for IDTs (1/10 of that currently recommended). No clear CR pattern emerged

Keywords : Allergy; cross reactions; drug hypersensitivity,proton; pump inhibitors.

        · abstract in Portuguese     · text in Portuguese     · Portuguese ( pdf )