Delayed hypersensitivity reaction to loperamide: An intriguing case report with positive challenge test

IgE-mediated allergy to proton pump inhibitors with both delayed and immediate onset

“…(4) Intervention of other neurotransmitters and mediators other than those released in immune IgE-mediated hypersensitivity [10] but our patient did have positive ST to different PPIs which is consistent with an IgE-mediated reaction.…”

“…(3) A decreased gastrointestinal permeability (even though an obvious cause was not found) and therefore delayed absorption of omeprazole has been suggested for other similar episodes with other drugs [10].…”

An unusual case of loperamide anaphylaxis

“…The authors wondered about possible altered bowel habits during gastroenteritis that affect systemic absorption or even a direct mast cell degranulation mechanism. 5 Indeed, loperamide is directly absorbed through the gut and is rapidly metabolized via the cytochrome P450 family in the liver, meaning little intact drug reaches the circulation. 6 In instances of gastroenteritis, increased stomach emptying may enhance systemic absorption in the small intestine.…”

“…The risk of cross-reactivity between peanut and soy is not believed to be clinically significant, and even in those with a proven peanut allergy, the avoidance of soy is not recommended without a history of clinical reactivity to soy. 4,5 Sustanon is in long-established use in endocrine services and is given in small, incremental starting doses to mimic natural puberty. 6,7 In our experience it is generally well tolerated, with the only reported incidents related to dosing errors (eg, the administration of a full 250-mg vial instead of the prescribed 50-mg initial dose).…”