Confino-Cohen Ronit, Goldberg Arnon
Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Tel-Aviv University Sackler School of Medicine, Tel-Aviv, Israel.
Ann Allergy Asthma Immunol. 2006 Jan;96(1):33-6. doi: 10.1016/S1081-1206(10)61037-X.
Omeprazole is an inhibitor of the parietal cell enzyme H+/K+ adenosine triphosphatase. Immediate-type hypersensitivity reactions, such as urticaria, angioedema, and hypotension, induced by omeprazole and other proton pump inhibitors are rare.
To confirm the immediate-type mechanism of recurrent anaphylactic reactions to the repeated administration of omeprazole using skin testing and to enable safe administration of the drug after successful oral desensitization.
Intradermal skin tests were performed with omeprazole (0.04 and 0.4 mg/mL) prepared from the oral and intravenous commercial preparations and with pantoprazole (0.02 and 0.2 mg/mL) prepared from the oral commercial preparation. Skin tests were repeated after completion of the desensitization. Oral desensitization was applied at a starting dose of 0.001 mg of omeprazole, and a full dose of 16 mg was achieved after 5.6 hours (cumulative dose of 32.6 mg).
Intradermal skin test results were positive to omeprazole and pantoprazole at all tested concentrations. After successful desensitization, omeprazole was administered in the full dose uneventfully. The wheal size of the intradermal skin tests performed after completion of the desensitization was significantly reduced.
When indicated, this newly designed desensitization protocol may be used in patients with omeprazole-induced anaphylaxis.
奥美拉唑是壁细胞酶H⁺/K⁺腺苷三磷酸酶的抑制剂。由奥美拉唑和其他质子泵抑制剂引起的速发型超敏反应，如荨麻疹、血管性水肿和低血压，较为罕见。
通过皮肤试验确认反复给予奥美拉唑后复发性过敏反应的速发机制，并在成功进行口服脱敏后实现该药物的安全给药。
用口服和静脉用市售制剂配制的奥美拉唑（0.04和0.4mg/mL）以及用口服市售制剂配制的泮托拉唑（0.02和0.2mg/mL）进行皮内皮肤试验。脱敏完成后重复进行皮肤试验。口服脱敏起始剂量为0.001mg奥美拉唑，5.6小时后达到16mg的全剂量（累积剂量32.6mg）。
在所有测试浓度下，皮内皮肤试验结果对奥美拉唑和泮托拉唑均呈阳性。脱敏成功后，顺利给予奥美拉唑全剂量。脱敏完成后进行的皮内皮肤试验风团大小显著减小。
在有指征时，这种新设计的脱敏方案可用于奥美拉唑诱发过敏反应的患者。
