6.3.c. Desensitization
A successful oral desensitization protocol has been reported in a
patient with omeprazole induced anaphylaxis and positive skin test
results with both omeprazole and pantoprazole.40 Oral
desensitization was performed with increasing doses, at 20-minute
intervals, with a starting dose of 0.001 mg. A final dose of 16 mg was
reached in 5.6 hours. The patient tolerated the drug without reactions
and completed fourteen days of treatment without any evidence of
hypersensitivity.40 Another successful oral
desensitization protocol with rabeprazole, in a patient with
pantoprazole induced anaphylaxis and cross-reactivity to all available
PPIs, has also been reported.70 In cases where a PPI
is essential for treatment and a safe alternative cannot be found, or a
complete allergy work-up cannot be performed, for e.g. due to the
severity of the reported reaction or patient refusal, desensitization
may be a useful approach.