Management of Hypersensitivity Reactions to Proton Pump Inhibitors: A Retrospective Experience

Background: Few studies assessing the use of epinephrine in drug-induced anaphylaxis (DIA) in the hospital setting are available. We utilized the Beijing Pharmacovigilance Database (BPD) to evaluate the appropriateness of epinephrine for DIA management. Methods: DIA cases collected in the BPD from January 2004 to December 2014 were adjudicated and analyzed for demographics, causative drugs, clinical signs, outcomes, initial treatment, route, dosing, and cardiovascular adverse events (CAE) of epinephrine. Results: DIA was primarily caused by antibiotics (38.4%), radiocontrast agents (11.9%), traditional Chinese medicine injections (10.9%), and chemotherapeutic drugs (10.3%). Only 708 (59.5%) patients received epinephrine treatment. Patients who received epinephrine were more likely to experience wheezing (p < 0.001) and respiratory arrest (p < 0.001). Among 518 patients with a complete record of the epinephrine administration route, the percentage of patients receiving it by intramuscular (IM) injection, subcutaneous (SC) injection, intravenous (IV) bolus injection, or IV continuous infusion was 16.9, 31.5, 43.5, and 8.1%, respectively. Among the 427 patients with a record of both the administration route and the dosing, an overdose was more likely with IV bolus (94.1%) in contrast to IM injection (56.6%; p < 0.001) or SC injection (43.7%; p < 0.001). Among the patients analyzed for CAE (n = 349), 17 patients accounted for 19 CAE, and 13 (76.5%) of these patients were overdosed with epinephrine. Conclusion: Underuse, inappropriate IV bolus use, and overdosing were the 3 major problems with epinephrine use in DIA in China. Educational training for health care professionals on the appropriate use of epinephrine in managing anaphylactic reactions is suggested.

Section: Discussionmentioning

confidence: 99%

Use of Epinephrine in Patients with Drug-Induced Anaphylaxis: An Analysis of the Beijing Pharmacovigilance Database

Wang

Ma²,

Xing

et al. 2017

“…To our knowledge, 3 major studies have been published on this subject before: one by Bonadonna et al [19] in 2012 and 2 by Kepil Özdemir et al in 2013 [20] and 2016 [21]. These 3 studies described PPI HSRs confirmed by skin tests or OPTs for 15, 34, and 21 patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…However, they can cause adverse events (AEs) such as hypersensitivity reactions (HSRs) [2-6]. Some case reports [7-16] and studies [17-21] have shown that cross-reactivity among PPIs does exist. The following 3 main patterns have been identified: reactions to a single PPI, selective cross-reactions, and cross-reactions with all PPIs.…”

Section: Introductionmentioning

confidence: 99%

Immediate-Type Hypersensitivity Cross-Reactions to Proton Pump Inhibitors: A Descriptive Study of Data from the French National Pharmacovigilance Database

Tourillon¹,

Mahé²,

Baron³

et al. 2018

Background: Proton pump inhibitors (PPIs) can trigger immediate-type hypersensitivity reactions (HSRs). Three main patterns of cross-reactivity have been identified: reactions to a single PPI, selective cross-reactions, and cross-reactions with all PPIs. Several hypotheses have been advanced, but no consensus has been reached. Objective: We sought to identify immediate-type hypersensitivity cross-reactions to PPIs using real-world data about hypersensitivity testing from French pharmacovigilance cases. Methods: Potentially relevant immediate-type HSRs reported from January 1985 to February 2015 were extracted from the French pharmacovigilance database using a standardized MedDRA query (SMQ). Cases describing skin tests or oral provocation tests (OPTs) performed with several PPIs that yielded at least one positive result were included. Results: The SMQ extracted 2,119 cases, 38 of which were included in our study. Data collected from skin tests and OPTs indicated cross-reactions with all PPIs (n = 1), reactions to a single PPI (n = 14), or selective cross-reactions (n = 23). Esomeprazole, omeprazole, and pantoprazole concerned 78% of all selective cross-reactions. In more than half of the cases (55.3%), only 2 PPIs were tested. Conclusion: To the best of our knowledge, this PPI cross-reactivity study is the largest to date in terms of population size, describing 38 immediate-type HSRs to PPIs explored by skin tests or OPTs. This paucity of data belies the lack of standardized procedures for PPI hypersensitivity testing. It is likely that PPI HSR workups in everyday clinical practice are often incomplete. Further research to gain insight into selective cross-reactions between PPIs is needed. In the meantime, thorough workups should be completed when a PPI is suspected to have triggered an HSR, instead of routine contraindication to all PPIs.

Section: Drug Hypersensitivity: the Triad Of Pathomechanism Diagnostmentioning

confidence: 99%

“…A retrospective analysis of hypersensitivity reactions to proton pump inhibitors showed lansoprazole to be the most frequently implicated drug, followed by pantoprazole, esomeprazole, rabeprazole, and omeprazole, as well as anaphylaxis being the most frequent manifestation [95]. Since cross-reactions among proton pump inhibitors may occur, alternative drugs should be included in the diagnostic workup [95]. Rapid desensitization in patients with drug hypersensitivity to biologics, such as rituximab, infliximab, cetuximab, and trastuzumab, for which a detailed protocol has been developed, has been documented as safe and effective [96].…”

Section: Drug Hypersensitivity: the Triad Of Pathomechanism Diagnostmentioning

confidence: 99%

Recent Advances in Clinical Allergy and Immunology

Simon

2018

Allergic diseases are of great concern because of their high prevalence, which is still rising in several regions, their impact on patients’ physical and psychological health, the huge burden they place on patients’ quality of life, as well as the socioeconomic consequences that they cause. Recent research has provided new data on both genetic and environmental risk factors of atopic/allergic diseases. The application of new technologies such as “omics” has allowed a better understanding of the pathogenesis and has helped with the identification of therapeutic targets. Immense progress has been made in developing and applying novel, targeted therapies, for example for asthma and urticaria. Intensive efforts are being made to find biomarkers that help to classify patients, to identify their potential responsiveness to specific therapies, and to monitor the disease severity. Based on recent insights in the pathogenesis of food allergy and drug hypersensitivity, novel strategies for diagnostics, allergen avoidance, and induction of tolerance have been developed. Here, we summarize important findings in the field of clinical allergy and immunology with a special focus on asthma, allergic rhinitis, atopic dermatitis, food allergy, urticaria, angioedema, and drug hypersensitivity.