Anaphylaxie auf Protonenpumpenhemmer

Abstract

Introduction: During the last years, increasing numbers of proton pump inhibitors have been introduced into the market and the range of indications for which they are used has expanded. In this context, also the reports on allergic reactions, particularly immediate type reactions, to representatives of this group have increased. Next to some single case reports on vasculitis, erythematous, bullous or exfoliative dermatitis and others, there are escalating numbers of reports on anaphylactoid reactions to omeprazole, pantoprazole and lansoprazole. So far, the diagnostic procedures have not been evaluated. Patients: We report on six patients with immediate-type hypersensitivity to pantoprazole, who underwent skin prick tests, intracutaneous tests and CAST as well as LTT. Results; All these test procedures were not useful as there were false positive as well as false negative results, therefore, skin tests and laboratory investigations were not sensitive enough. So far, provocation tests are still the gold standard. Conclusion; Currently, accidental reexposures or controlled provocation tests are the most reliable tools in the clinical diagnosis of these reactions. This may be due to the fact that proton pump inhibitors are rapidly metabolized by the gastric parietal cells to a sulfonamide derivative. As one explanation, the hypersensitivity reaction may occur to the metabolite and not to the parent drug. However, experienced physicians should only do provocation tests under intensive surveillance conditions.