Esomeprazole
- PDF / 170,547 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 42 Downloads / 141 Views
1 S
Anaphylaxis: case report A 44-year-old woman developed anaphylaxis during treatment with esomeprazole for dyspepsia and abdominal discomfort. The woman presented to the anaphylaxis clinic after the first episode of anaphylaxis. She had prescribed esomeprazole tablet 20mg daily as needed for dyspepsia, which she took occasionally. Two months before the presentation, she took one tablet of esomeprazole 20mg for dyspepsia and abdominal discomfort and paracetamol. Within 10 minutes, she developed generalised pruritus and was collapsed at home. After hitting the floor, she awoke and called an ambulance. Subsequently, the woman was treated with epinephrine [adrenaline] in the ambulance due to low systolic BP. Her initial laboratory test results showed an elevated level of acute tryptase. Initially, wheat or wheat-dependent cofactor augmented anaphylaxis was suspected. Hence, she was advised to avoid cyclooxygenase inhibitors, wheat and proton pump inhibitors till review. At the current presentation, her specific immunoglobulin E test to omega-5-gliadin and wheat were negative. Also, the skin prick test (SPT) with the wheat solution and prick-to-prick to the index bread slice was negative. Intradermal tests (IDT) and SPT to paracetamol were also negative. She underwent an oral challenge test with paracetamol 500mg with a slice of the same index bread showed no adverse reaction. Thereafter, SPT with histamine (positive control) and normal saline (negative control) were positive at 5mm and negative at 0mm, respectively. The SPT with esomeprazole showed borderline positive results with a 3mm wheal and flare. IDT with esomeprazole was also positive at concentrations of 0.08 mg/mL, 0.8 mg/mL and 8 mg/mL, with 3mm, 8mm and 18mm wheal expansion, respectively. Of note, SPT and IDT test results were negative in health control. To evaluate potential crossreactivity, SPT and IDT with pantoprazole were performed, which were negative for SPT and positive for IDT. Therefore, a diagnosis of severe hypersensitivity type I (anaphylaxis) to esomeprazole was made. Laboratory tests also confirmed cross-sensitisation to pantoprazole. Because of clinical history, high risk of anaphylaxis and strongly positive skin tests, drug provocation tests were not performed. She denied further testing with other proton pump inhibitors. Eventually, she was prescribed famotidine for dyspepsia with no complications [outcome of ADR not stated]. Li PH. Skin testing for hypersensitivity and cross-reactivity between proton pump inhibitors. Hong Kong Medical Journal 26: 450e1-450e2, No. 5, Oct 2020. Available from: 803518012 URL: http://doi.org/10.12809/hkmj198267
0114-9954/20/1832-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 28 Nov 2020 No. 1832
Data Loading...
