Natsch S, Vinks M H, Voogt A K, Mees E B, Meyboom R H
Department of Clinical Pharmacy, University Hospital Nijmegen, The Netherlands.
Ann Pharmacother. 2000 Apr;34(4):474-6. doi: 10.1345/aph.19235.
To report two cases of anaphylactic reactions to proton-pump inhibitors (PPIs).
A 54-year-old woman who had taken omeprazole in the past was treated with omeprazole 40 mg and developed periorbital edema, edema of the skin, pruritus, nausea, and vomiting about 45 minutes after taking one capsule. Five months later, she was treated with lansoprazole 30-mg capsules. Again, within 45 minutes she developed an even more serious reaction, with pruritus and urticaria on her whole body, increased sweating, facial edema, and loss of consciousness. A 61 -year-old man took one tablet of pantoprazole 40 mg one year after first being treated with the drug. Within hours after ingestion, he developed malaise, generalized pruritus and urticaria, a swollen tongue and eyes, and diffuse sweating; his blood pressure decreased to 75/50 mm Hg.
Because of the acute onset of symptoms and close temporal association with exposure to the drug, as well as previous exposure to it, the reactions can be classified as anaphylactic shock to PPIs. These benzimidazole derivatives are chemically related; observations in a few patients, such as the first case above, suggest that cross-sensitivity may occur. The Uppsala Monitoring Centre (UMC) has received a total of 42 reports of anaphylactic reactions or anaphylactic shock in association with PPIs. These reports account for 0.2% of the total of reported suspected adverse drug reactions to PPIs, compared with 0.8% anaphylactic reactions in the UMC database as a whole.
These findings suggest that the chemically related PPIs can, as a group, cause anaphylactic reactions; however, the rate is comparatively low. Since anaphylaxis is a potentially serious reaction, more precise information is needed regarding its frequency, and healthcare professionals need to be aware of this possibility when prescribing these agents.
报告两例质子泵抑制剂（PPIs）过敏反应的病例。
一名54岁女性既往服用过奥美拉唑，此次服用40毫克奥美拉唑治疗，服用一粒胶囊后约45分钟出现眶周水肿、皮肤水肿、瘙痒、恶心和呕吐。五个月后，她服用30毫克兰索拉唑胶囊进行治疗。同样，在45分钟内她出现了更严重的反应，全身瘙痒和荨麻疹、出汗增多、面部水肿和意识丧失。一名61岁男性在首次接受泮托拉唑40毫克治疗一年后服用了一片该药物。服药后数小时内，他出现不适、全身瘙痒和荨麻疹、舌头和眼睛肿胀以及全身出汗；血压降至75/50毫米汞柱。
由于症状急性发作且与药物暴露时间密切相关，以及既往有过药物暴露史，这些反应可归类为对PPIs的过敏性休克。这些苯并咪唑衍生物在化学上相关；对少数患者的观察，如上述首例患者，提示可能发生交叉过敏。乌普萨拉监测中心（UMC）共收到42例与PPIs相关的过敏反应或过敏性休克报告。这些报告占PPIs报告的可疑药物不良反应总数的0.2%，而在UMC数据库中，过敏性反应总体占比为0.8%。
这些发现表明，化学相关的PPIs作为一个整体可引起过敏反应；然而，发生率相对较低。由于过敏反应是一种潜在的严重反应，需要更精确的关于其发生频率的信息，医疗保健专业人员在开具这些药物处方时需要意识到这种可能性。
