Advertisement

Immediate and Delayed Hypersensitivity Reactions to Proton Pump Inhibitors: Evaluation and Management

  • Iris M. OtaniEmail author
  • Aleena Banerji
Anaphylaxis and Drug Allergy (DA Khan and M Castells, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Anaphylaxis and Drug Allergy

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.

Keywords

Drug allergy Hypersensitivity reaction Adverse drug reaction Proton pump inhibitor PPI Skin testing Patch testing 

Notes

Compliance with Ethical Standards

Conflict of Interest

Drs. Otani and Banerji declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kantor E, Rehm C, Haas J, Chan A, Giovannucci E. Trends in prescription drug use among adults in the United States From 1999–2012. JAMA. 2015;314:1818–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Barrison A, Jarboe L, Weinberg B, Nimmagadda K, Sullivan L, Wolfe MM. Patterns of proton pump inhibitor use in clinical practice. Am J Med. 2001;111:469–73.CrossRefPubMedGoogle Scholar
  3. 3.
    Unknown. Ament AFP 2012.pdf.Google Scholar
  4. 4.••
    Bose S, Guyer A, Long A, Banerji A. Evaluation and management of hypersensitivity to proton pump inhibitors. Ann Allergy Asthma Immunol. 2013;111:452–7. Comprehensive review of immune-mediated reactions to omeprazole reported between June 1986 and September 2012.CrossRefPubMedGoogle Scholar
  5. 5.••
    Özdemir S, Yılmaz İ, Aydın Ö, Büyüköztürk S, Gelincik A, Demirtürk M, et al. 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. Prospective study evaluating diagnostic value of skin testing in evaluating immediate hypersensitivity reactions to PPIs.CrossRefGoogle Scholar
  6. 6.•
    Sánchez-Morillas L, Rojas Pérez-Ezquerra P, González Mendiola R, Gómez-Tembleque Ubeda P, Santos Alvarez A, Laguna-Martínez JJ. Eleven cases of omeprazole hypersensitivity: diagnosis and study of cross-reactivity. J Investig Allergol Clin Immunol. 2014;24:130–2. Case series of 11 patients evaluated for IgE-mediated reactions to omeprazole with skin testing.PubMedGoogle Scholar
  7. 7.
    Al-Falah K, Schachter J, Sasseville D. Occupational allergic contact dermatitis caused by omeprazole in a horse breeder. Contact Dermatitis. 2014;71:377–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Alwan W, Banerjee P, White I. Occupational contact dermatitis caused by omeprazole in a veterinary medicament. Contact Dermatitis. 2014;71:376–6.Google Scholar
  9. 9.
    Bourneau-Martin D, Leclech C, Jamet A, Drablier G, Trenque T, Juengel K, et al. Omeprazole-induced drug reaction with eosinophilia and systemic symptoms (DRESS). Eur J Dermatol EJD. 2014;24:413–5.PubMedGoogle Scholar
  10. 10.
    Schiller D, Maieron A, Schöfl R, Donnerer J. Drug fever due to a single dose of pantoprazole. Pharmacology. 2014;94:78–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Jones EK, Mingioni N, Lee JB. Widespread scaly eruption in a patient with multiple comorbidities. JAMA. 2015;314:1740–1.CrossRefPubMedGoogle Scholar
  12. 12.••
    Ghatan P, Marcusson-Ståhl M, Matura M, Björkheden C, Lundborg P, Cederbrant K. Sensitization to omeprazole in the occupational setting. Contact Dermatitis. 2014;71:371–5. Case series of 96 patients evaluated for cutaneous eruptions due to occupational exposure to omeprazole.CrossRefPubMedGoogle Scholar
  13. 13.••
    Sandholdt LH, Laurinaviciene R, Bygum A. Proton pump inhibitor-induced subacute cutaneous lupus erythematosus. Br J Dermatol. 2014;170:342–51. Case series of 19 patients with PPI-induced subacute cutaneous lupus erythematosus.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Candar M, Gunes H, Boz B, Kandis H, Kutlucan L, Saritas A. Asystole after the first dose of lansoprazole. Am J Emerg Med. 2014;32:1302.e3–4.CrossRefGoogle Scholar
  15. 15.
    Kara M, Tanoglu A, Kutlu A, Sirkeci O, Kekilli M. Esomeprazole: a safe alternative to lansoprazole allergy? Iran J Allergy Asthma Immunol. 2014;13:296–7.PubMedGoogle Scholar
  16. 16.
    Barbaud, Collet, Milpied, Assier, Staumont, Avenel-Audran, et al. A multicentre study to determine the value and safety of drug patch tests for the three main classes of severe cutaneous adverse drug reactions. Br J Dermatol. 2013;168:555–62.CrossRefPubMedGoogle Scholar
  17. 17.
    Schmidt C. Global opportunities for proton pump inhibitors. 2014.Google Scholar
  18. 18.
    Sheikh I, Waghray A, Waghray N, Dong C, Wolfe M. Consumer use of over-the-counter proton pump inhibitors in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2014;109:789–94.CrossRefPubMedGoogle Scholar
  19. 19.
    Elfau M, Sotillos M, Clavería L, Arazuri N, Ballarin S, Sanz C. Study of cross-reactivity between proton pump inhibitors. J Invest Allerg Clin. 2010;20:157–61.Google Scholar
  20. 20.
    Garrido Fernández S, Cumplido JA, Rábano A, Martínez D, Blanco C, Carrillo T. Allergy to proton pump inhibitors: diagnosis and assessment of cross-reactivity. J Investig Allergol Clin Immunol. 2008;18:140–1.PubMedGoogle Scholar
  21. 21.
    Porcel S, Rodríguez A, Jiménez S, Alvarado M, Hernández J. Allergy to lansoprazole: study of cross-reactivity among proton-pump inhibitors. Allergy. 2005;60:1087–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Bonadonna P, Lombardo C, Bortolami O, Bircher A, Scherer K, Barbaud A, et al. Hypersensitivity to proton pump inhibitors: diagnostic accuracy of skin tests compared to oral provocation test. J Allergy Clin Immunol. 2012;130:547–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Pimiento AJ, Lastra L, Cabreros MI, Sánchez LA, Mosquera M, Cubero A. Hypersensitivity to lansoprazole and rabeprazole with tolerance to other proton pump inhibitors. J Allergy Clin Immun. 2006;117:707–8.CrossRefGoogle Scholar
  24. 24.
    Vovolis V, Koutsostathis N, Stefanaki E. IgE-mediated anaphylaxis to proton pump inhibitors-cross-reacting study. Allergy. 2008;63:1251–2.CrossRefPubMedGoogle Scholar
  25. 25.
    Demirkan K, Bozkurt B, Karakaya G, Kalyoncu A. Anaphylactic reaction to drugs commonly used for gastrointestinal system diseases: 3 case reports and review of the literature. J Invest Allerg Clin. 2006;16:203–9.Google Scholar
  26. 26.
    Pérez-Ezquerra P, Morillas L, Martínez J, Fernández G, Gomez-Tembleque M, Alvarez A, et al. Anaphylaxis to omeprazole. Cross-reactivity with the other proton pump inhibitors. Allergol Immunopath. 2011;39:54.CrossRefGoogle Scholar
  27. 27.
    Stefanaki EC, Vovolis V, Letsa I, Koutsostathis N. Anaphylactic reaction to omeprazole. Am J Gastroenterol. 2008;103:1581–3.CrossRefPubMedGoogle Scholar
  28. 28.
    Drug allergy: an updated practice parameter. Ann. Allergy Asthma Immunol. 2010;105:259–273.Google Scholar
  29. 29.
    Confino-Cohen R, Goldberg A. Anaphylaxis to omeprazole: diagnosis and desensitization protocol. Ann Allergy Asthma Immunol. 2006;96:33–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Lobera T, Navarro B, Pozo M, González I, Blasco A, Escudero R, et al. Nine cases of omeprazole allergy: cross-reactivity between proton pump inhibitors. J Invest Allerg Clin. 2009;19:57–60.Google Scholar
  31. 31.
    Conde-Salazar L, Blancas-Espinosa R, Pérez-Hortet C. Occupational airborne contact dermatitis from omeprazole. Contact Dermatitis. 2007;56:44–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Meding B. Contact allergy to omeprazole. Contact Dermatitis. 1986;15:36–51.CrossRefGoogle Scholar
  33. 33.
    Vilaplana J, Romaguera C. Allergic contact dermatitis due to lansoprazole, a proton pump inhibitor. Contact Derm. 2001;44:47–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Sanz-Gallén P, Nogué S, Herrera-Mozo I, Delclos GL, Valero A. Occupational contact allergy to omeprazole and fluoxetine. Contact Derm. 2011;65:118–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Hausen BM, Lücke R, Rothe E, Erdogan A, Rinder H. Sensitizing capacity of azole derivatives: Part III. Investigations with anthelmintics, antimycotics, fungicides, antithyroid compounds, and proton pump inhibitors. Am. J. Contact Dermatitis. 2000;11:80–8.CrossRefGoogle Scholar
  36. 36.
    Caboni S, Gunera-Saad N, Ktiouet-Abassi S, Berard F, Nicolas J. Esomeprazole-induced DRESS syndrome. Studies of cross-reactivity among proton-pump inhibitor drugs. Allergy. 2007;62:1342–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Heaton N, Edmonds E, Francis N, Bunker C, Bowling J, Morar N. Fatal toxic epidermal necrolysis due to lansoprazole. Clin Exp Dermatol. 2004;29:612–3.CrossRefPubMedGoogle Scholar
  38. 38.
    Odeh M, Lurie M, Oliven A. Cutaneous leucocytoclastic vasculitis associated with omeprazole. Postgrad Med J. 2002;78:114–5.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Correia O, Viana H, Azevedo R, Delgado L, Polónia J. Possible phototoxicity with subsequent progression to discoid lupus following pantoprazole administration. Clin Exp Dermatol. 2001;26:455–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Dam C, Bygum A. Subacute cutaneous lupus erythematosus induced or exacerbated by proton pump inhibitors. Acta Derm-Venereol. 2008;88:87–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Bracke A, Nijsten T, Vandermaesen J, Meuleman L, Lambert J. Lansoprazole-induced subacute cutaneous lupus erythematosus: two cases. Acta Derm-Venereol. 2005;1:1–1.CrossRefGoogle Scholar
  42. 42.
    Panting K, Pinto M, Ellison J. Lansoprazole-induced subacute cutaneous lupus erythematosus. Clin Exp Dermatol. 2009;34:733–4.CrossRefPubMedGoogle Scholar
  43. 43.
    Mankia, Rytina, Burrows. Omeprazole-induced subacute cutaneous lupus erythematosus. Clin Exp Dermatol Wiley. 2010;35:e1–2.CrossRefGoogle Scholar
  44. 44.
    Toms-Whittle L, John L, Buckley D. Drug-induced subacute cutaneous lupus erythematosus associated with omeprazole. Clin Exp Dermatol. 2011;36:281–3.CrossRefPubMedGoogle Scholar
  45. 45.
    Wee J, Natkunarajah J, Marsden R. A difficult diagnosis: drug-induced subacute cutaneous lupus erythematosus (SCLE) triggered by omeprazole in a patient with pre-existing idiopathic SCLE. Clin Exp Dermatol. 2012;37:445–6.CrossRefPubMedGoogle Scholar
  46. 46.
    McCourt C, Somerville J, McKenna K. Anti-Ro and anti-La antibody positive subacute cutaneous lupus erythematosus (SCLE) induced by lansoprazole. Eur J Dermatol. 2010;20:860–1.PubMedGoogle Scholar
  47. 47.
    Almebayadh M, Regnier-Rosencher E, Carlotti A, Goulvestre C, Guern V, Mouthon L, et al. Subacute cutaneous lupus erythematosus induced and exacerbated by proton pump inhibitors. Dermatology. 2013;226:119–23.CrossRefPubMedGoogle Scholar
  48. 48.
    Alcántara-González J, Truchuelo-Díez MT, González-García C, Jaén Olasolo P. [Esomeprazole-induced subacute cutaneous lupus erythematosus]. Actas Dermosifil. 2011;102:638–40.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Medicine, Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations