Delayed‐type hypersensitivity reactions induced by proton pump inhibitors: A clinical and in vitro T‐cell reactivity study
| Autor: | C.-H. Yang, W.-M. Ke, Chien-Yio Lin, Wen-Hung Chung, C.-Y. R. Hui, W.-W. Chen, Chi-Yuan Cheng, Chuang Wei Wang, Ya-Ching Chang |
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| Rok vydání: | 2017 |
| Předmět: |
Male
0301 basic medicine Drug T-Lymphocytes media_common.quotation_subject Immunology Cross Reactions Pharmacology Lymphocyte Activation Esomeprazole Immune tolerance Drug Hypersensitivity 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Immune Tolerance Humans Immunology and Allergy Medicine Eosinophilia Hypersensitivity Delayed Granulysin Skin Tests media_common business.industry Proton Pump Inhibitors medicine.disease Toxic epidermal necrolysis 030104 developmental biology Tolerability Cytokines Female Steroids Symptom Assessment medicine.symptom business Type I hypersensitivity medicine.drug |
| Zdroj: | Allergy. 73:221-229 |
| ISSN: | 1398-9995 0105-4538 |
| DOI: | 10.1111/all.13235 |
| Popis: | Background Proton pump inhibitors (PPIs) have been known to induce type I hypersensitivity reactions. However, severe delayed-type hypersensitivity reactions (DHR) induced by PPI, such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or drug rash with eosinophilia and systemic symptoms (DRESS), are rarely reported. We conducted a study of a large series of PPI-related DHR, followed up their tolerability to alternative anti-ulcer agents, and investigated the T-cell reactivity to PPI in PPI-related DHR patients. Methods We retrospectively analyzed patients with PPI-related DHR from multiple medical centers in Taiwan during the study period January 2003 to April 2016. We analyzed the causative PPI, clinical manifestations, organ involvement, treatment, and complications. We also followed up the potential risk of cross-hypersensitivity or tolerability to other PPI after their hypersensitivity episodes. Drug lymphocyte activation test (LAT) was conducted by measuring granulysin and interferon-γ to confirm the causalities. Results There were 69 cases of PPI-related DHR, including SJS/TEN (n=27) and DRESS (n=10). The LAT by measuring granulysin showed a sensitivity of 59.3% and specificity of 96.4%. Esomeprazole was the most commonly involved in PPI-related DHR (51%). Thirteen patients allergic to one kind of PPI could tolerate other structurally different PPI without cross-hypersensitivity reactions, whereas three patients developed cross-hypersensitivity reactions to alternative structurally similar PPI. The cross-reactivity to structurally similar PPI was also observed in LAT assay. Conclusions PPIs have the potential to induce life-threatening DHR. In patients when PPI is necessary for treatment, switching to structurally different alternatives should be considered. |
| Databáze: | OpenAIRE |
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