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Free Content Hypersensitivity reactions to proton-pump inhibitors: Clinical presentation, diagnosis, and management

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Proton-pump inhibitors (PPI) are one of the most commonly prescribed drugs, and they are generally well tolerated. However, several immediate and delayed hypersensitivity reactions due to PPIs have been reported.


To review the clinical characteristics and management of immune-mediated immediate and delayed hypersensitivity reactions to PPIs.


We performed a search of a medical literature data base from January 1980 to October 2019 by using keywords that included “proton-pump inhibitors” and “hypersensitivity.”


Anaphylaxis is the most-common clinical presentation in patients with immediate hypersensitivity reactions to PPIs, followed by urticaria and/or angioedema. Occupational contact dermatitis, maculopapular eruption, fixed drug eruption, symmetrical drug-related intertriginous and flexural exanthema, and severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis have also been reported with PPIs.


The current knowledge and severity of the reported reactions indicated the importance of consideration of a causal relationship between hypersensitivity reactions and PPIs, and awareness of the existence of cross-reactivity among PPIs.

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Keywords: Allergy; dexlansoprazole; esomeprazole; hypersensitivity; lansoprazole; omeprazole; pantoprazole; proton-pump inhibitors; rabeprazole; skin tests

Document Type: Research Article

Affiliations: 1: From the Division of Allergy and Immunology, Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey, and 2: Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey

Publication date: March 1, 2020

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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