What question did this study set out to answer?

This study aims to explore the clinical features and diagnostic challenges of immediate-type hypersensitivity reactions to proton pump inhibitors.

March 1, 2026Open Access

Immediate-Type PPI Hypersensitivity as a Severe Adverse Drug Reaction: Diagnostic Challenges, Cross-Reactivity, and Real-Life Outcomes

Key Points

This study aims to explore the clinical features and diagnostic challenges of immediate-type hypersensitivity reactions to proton pump inhibitors.
Conducted a single-center ambispective analysis of 40 patients evaluated for immediate-type hypersensitivity reactions to PPIs.
Retrospectively recorded index reactions, implicated PPIs, and results from skin tests or drug provocation testing.
Followed patients who tolerated an alternative PPI through structured telephone interviews.
Lansoprazole was identified as the most common culprit in 50% of cases.
65% of patients experienced anaphylaxis, and skin tests were positive for 25% of participants.
Cross-reactivity was observed in 25% of patients, primarily between lansoprazole and pantoprazole.
40.7% of patients restarted PPIs post-testing without recurrence, while behavioral barriers prevented others from resuming therapy.

Abstract

Background/Objectives: Immediate-type hypersensitivity reactions (HSRs) to proton pump inhibitors (PPIs) represent a clinically relevant adverse drug reaction and pose diagnostic and management challenges, including variable cross-reactivity (CR). Drug provocation testing (DPT) is the diagnostic gold standard, but real-life use after testing remains uncertain. This study aimed to describe clinical features, diagnostic outcomes, CR profiles, and real-life PPI use in patients with immediate-type PPI hypersensitivity. Methods: Single-center ambispective study of 40 patients evaluated for immediate-type PPI HSRs (2014–2023). Index reactions, culprit PPI, and skin test/DPT results were recorded retrospectively. Patients tolerating an alternative PPI on DPT were followed prospectively; real-life tolerance and use were assessed by structured telephone interview. Results: Among 40 patients (87.5% female; mean age 48 years), lansoprazole was the most frequent culprit (50%); anaphylaxis occurred in 65%. Skin tests were positive in 25% (n = 9), and a shorter interval from reaction to testing was associated with positivity (p = 0.025). CR was detected in 25% (n = 10), most often between lansoprazole and pantoprazole. All 29 patients undergoing DPT tolerated at least one alternative PPI. In real-life follow-up (n = 27), 11 (40.7%) restarted PPIs without recurrence; 1 (3.7%) developed a mild cutaneous reaction despite negative testing. Fifteen (55.6%) did not restart therapy; 4 (14.8%) cited drug-related anxiety or physician-advised avoidance. Conclusions: In immediate-type PPI hypersensitivity, skin test sensitivity appears time-dependent, supporting early evaluation. DPT identifies safe alternatives, yet behavioral and clinician-related barriers limit real-life implementation; addressing these barriers is essential to optimize PPI allergy management.

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Cite This Study

Kural et al. (Fri,) studied this question.

synapsesocial.com/papers/69a3d824ec16d51705d2eb33 https://doi.org/https://doi.org/10.3390/jcm15051808

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