Algorithm for management of immediate HSRs to PPIs
A great portion of the patients with immediate HSR to PPIs refer more
than one episode with the same drug, probably related to the fact that
these drugs are usually not suspected as triggers of HSRs by
physicians.19 Therefore, the first step in the
management of immediate HSRs to PPIs is to consider a possible
cause-effect relationship between PPIs and HSRs. Given the specificity
of skin tests in immediate PPI HSRs, these should precede the DPTs with
the culprit or an alternative PPI. In case of negative skin test results
a DPT is required to exclude PPI hypersensitivity. The choice of the
alternative PPI should be based on the results of in vivo and in vitro
(when available) tests, and DPTs should be performed with PPIs tested
negative. An algorithm that outlines the management of PPI HSRs is
provided in Figure 1.