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Esomeprazole‐induced DRESS syndrome. Studies of cross‐reactivity among proton‐pump inhibitor drugs
Author(s) -
Caboni S.,
GuneraSaad N.,
KtiouetAbassi S.,
Berard F.,
Nicolas J. F.
Publication year - 2007
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/j.1398-9995.2007.01428.x
Subject(s) - esomeprazole , medicine , citation , proton pump inhibitor , library science , gastroenterology , computer science
intervals of 1, 2 and 4 weeks between the sessions. The persistence of negative results of intradermal testing was confirmed before each desensitization procedure. Loss of skin sensitivity appeared to be a good predictor of tolerance of the drug. Both patients continued receiving cyanocobalamin injections monthly with good tolerance. Drug desensitization is time dependant and re-sensitization recurs after awhile.We have little information about the length of time the drug tolerance persists. It is thought to be in the range of weeks. According to our experience, with the above patients, it persists for at least 4 weeks. We did not asses a longer time interval and therefore would advise four weekly treatmentwith the therapeuticdose. Our patients showed cross sensitivity between cyanocobalamin and hydroxicobalamin therefore we had no substitute drug available. Cross sensitivity has previously been described although it is not always found (2, 3). In a patient with hydroxicobalamin allergy and a negative result to cutaneous testing with cyanocobalamin, this latter preparation may be tolerated. We have not been able to measure specific IgE in patients serum, though the mechanism is likely to be IgE dependant. We suspect this to be true as both sensitizations occurred after a period of tolerance with increasing severity of the reaction after each injection. We were able to confirm positive skin test results in our patients as compared with negative test results in control subjects. The preparation of cyanocobalamin we used did not contain benzyl alcohol preservative which has been involved in patient reacting to vitamin B12 injection (4). The allergen involved in vitamin B12 reactions is likely to be a hapten. We are indebted to Lucy Riddington, allergy specialist nurse, for technical support.