I would like to make some comments about the report entitled "Toxic epidermal necrolysis induced by lansoprazole," published by Fracaroli et al. in 2013.11. Fracaroli TS, Miranda LQ, Sodré JL, Chaves M, Gripp A. Toxic epidermal necrolysis induced by lansoprazole*. An Bras Dermatol. 2013;88:116-9. I also aim to add some recent evidence about the growing and alarming incidence of adverse drug reactions (ADR) after the use of proton pump inhibitors (PPIs) to this relevant article.
Some authors attribute this phenomenon to the current popularity of these drugs in both hospitals and outpatient enviroments.22. Chang YS. Hypersensitivity reactions to proton pump inhibitors. Curr Opin Allergy Clin Immunol. 2012;12:348-53. Some evidence also points to possible under-notification of the reactions caused by PPIs, as they are wrongly regarded as symptomatic drugs and routinely prescribed in combination with other compounds.33. de Vries AC, Kuipers EJ. Helicobacter pylori infection and nonmalignant diseases. Helicobacter. 2010;15 Suppl 1:29-33.
Little is known about the immunopathological mechanism of these reactions; however, a diverse spectra of Gel and Coombs classification have been described.22. Chang YS. Hypersensitivity reactions to proton pump inhibitors. Curr Opin Allergy Clin Immunol. 2012;12:348-53. It is important to mention that the metabolism of PPIs results in the formation of the active compounds sulfenic acids and sulfonamide.22. Chang YS. Hypersensitivity reactions to proton pump inhibitors. Curr Opin Allergy Clin Immunol. 2012;12:348-53. Omeprazole, the most widely used PPI, is a subject of frequent discussion regarding its potential to generate cross-reaction with classic sulfonamides. Cross-reactivity between the different PPIs is also known.44. Sobrevia Elfau MT, Garcés Sotillos M, Ferrer Clavería L, Segura Arazuri N, Monzón Ballarin S, Colás Sanz C. Study of cross-reactivity between proton pump inhibitors. J Investig Allergol Clin Immunol. 2010;20:157-61.
Restrictions on the use of medications with possible cross-reaction with sulphonamides are controversial. However, one must be careful in the case of patients with proven sensitivity to drugs such as sulfadiazine and sulfamethoxazole.22. Chang YS. Hypersensitivity reactions to proton pump inhibitors. Curr Opin Allergy Clin Immunol. 2012;12:348-53. , 55. Chantachaeng W, Chularojanamontri L, Kulthanan K, Jongjarearnprasert K, Dhana N. Cutaneous adverse reactions to sulfonamide antibiotics. Asian Pac J Allergy Immunol. 2011;29:284-9. In addition, the PPIs should not be prescribed as simple symptomatic medicine to patients who have already developed ADR.
Drug metabolism and possible cross-reactions should always be considered, especially in the case of known hypersensitivity and potential severe ADR.
REFERENCES
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1Fracaroli TS, Miranda LQ, Sodré JL, Chaves M, Gripp A. Toxic epidermal necrolysis induced by lansoprazole*. An Bras Dermatol. 2013;88:116-9.
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2Chang YS. Hypersensitivity reactions to proton pump inhibitors. Curr Opin Allergy Clin Immunol. 2012;12:348-53.
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3de Vries AC, Kuipers EJ. Helicobacter pylori infection and nonmalignant diseases. Helicobacter. 2010;15 Suppl 1:29-33.
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4Sobrevia Elfau MT, Garcés Sotillos M, Ferrer Clavería L, Segura Arazuri N, Monzón Ballarin S, Colás Sanz C. Study of cross-reactivity between proton pump inhibitors. J Investig Allergol Clin Immunol. 2010;20:157-61.
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5Chantachaeng W, Chularojanamontri L, Kulthanan K, Jongjarearnprasert K, Dhana N. Cutaneous adverse reactions to sulfonamide antibiotics. Asian Pac J Allergy Immunol. 2011;29:284-9.
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*
Work conducted at the Department of Dermatology - University Hospital of Brasilia (Hospital Universitário de Brasília - HUB); University of Brasilia (Universidade de Brasília - UnB)
Publication Dates
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Publication in this collection
June 2013
History
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Received
20 Mar 2013 -
Accepted
22 Mar 2013
