Anaphylaxis to lansoprazole with tolerance to other proton pump inhibitors
Abstract
Backgrounds: Anaphylaxis to proton pump inhibitors (PPIs) have been rarely reported. Different patterns of cross-reactivity between PPIs have been also demonstrated using skin tests. Here, we report a case of anaphylaxis to lansoprazole with tolerance to other commercially available PPIs, which was proven by skin tests and oral provocation tests. Case history: A 47-year-old female visited our emergency room with sudden onset of whole body urticaria, facial swelling, dyspnea, and loss of consciousness that developed one hour after ingestion of 30 mg lansoprazole and 50 mg itopride for her episodic epigastric soreness. Skin prick test (SPT) and intradermal test (IDT) with lansoprazole, esomeprazole, rabeprazole, and pantoprazole were performed. Lansoprazole (0.003 mg/mL) showed positive reactions on both SPT and IDT. Rabeprazole (3 mg/mL) showed positive reaction only in IDT. SPT and IDT with esomeprazole and rabeprazole were all negative. Oral provocation tests (OPTs) with 30 mg lansoprazole was positive showing generalized rash and facial swelling 30 minuites after ingestion, while OPTs with 40 mg esomeprazole, 40 mg pantoprazole and 20 mg rabeprazole were negative. Conclusion: In case of anaphylaxis to PPIs, other PPIs could be safe alternatives. Skin tests seems to be helpful to define cross-reactivity between PPIs.
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