Conclusion
Although, except in long-term use, PPIs are generally well tolerated,
their widespread use has been associated with immediate and delayed
HSRs, some of which might be life threatening. Correct identification of
PPI HSRs and of safe alternative drugs for future use is crucial to
prevent severe drug reactions and unnecessary avoidance of the whole PPI
group. Skin tests are useful in diagnosing immediate HSRs to PPIs,
however, their sensitivity is low. There is a substantial
cross-reactivity between PPIs, which can be assessed first by skin
testing and subsequently by DPT in immediate HSRs. Cross-reactivity
rates between PPIs in immediate type HSRs are analyzed according to the
available studies and are given in the current PP to guide the selection
of possible alternative PPIs for diagnostic tests. Although rarely
reported we need to be aware of the potential whole group
cross-reactivity in the setting of both immediate and non-immediate PPI
HSRs. Data regarding delayed PPI HSRs are limited. There are several
unmet needs that require further research in this topic and greater
knowledge on the management of PPI induced HSRs.