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.