Emergency. 2018; 6 (1): e34 CA S E RE P O RT Anaphylaxis as a Rare Side Effect of Pantoprazole; a Case Report Gholamreza Faridaalaee1, Javad Ahmadian Heris2,3∗ 1. Department of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, Iran. 2. Department of Allergy and Clinical Immunology, Pediatric Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. 3. Department of Allergy and Clinical Immunology, Rasool-E-Akram Hospital, Iran University Of Medical Sciences, Tehran, Iran. Received: February 2018; Accepted: April 2018; Published online: 21 May 2018 Abstract: Anaphylaxis is a serious life-threatening allergic reaction. Any medication may potentially trigger anaphylaxis, but reaction to pantoprazole is rare. Our case is a 21 year-old girl with anaphylactic reaction to pantoprazole a short time after prescription. Keywords: pantoprazole; anaphylaxis; proton pump inhibitors; hypersensitivity © Copyright (2018) Shahid Beheshti University of Medical Sciences Cite this article as: Faridaalaee Gh, Ahmadian Heris J. Anaphylaxis as a Rare Side Effect of Pantoprazole; a Case Report. Emergency. 2018; 6 (1): e34. 1. Introduction Pantoprazole is one of the proton pump inhibitor agents, which was first introduced in 1994. Pantoprazole and other proton pump inhibitors (PPIs) reduce acid production and its indications are treatment of erosive gastritis, esophagitis, gastric ulcer, duodenal ulcer and Zollinger Ellison syndrome (1). Many side effects have been reported following panto- prazol usage but it has rarely been reported as a cause of ana- phylaxis. Here, we present a case of anaphylactic reaction to intravenous pantoprazole in a young woman who had pre- sented to emergency department following epigastric pain. 2. Case presentation: The case is a 21-year-old woman who was brought to emegency department of Amiralmomenin Hospital, Maragheh, Iran, with epigastric pain, which had started 2 days before. The pain was localized, did not radiated to any- where, and was slightly relived with eating and exacerbated after half an hour. She did not have bloody vomit or Melena. She had loose defecation three times a day. Vital signs were as follow: blood pressure = 80/120 mmHg, heart rate = 72 beat/minute, respiratory rate = 14 beat/minute, and arterial ∗Corresponding Author: Javad Ahmadian Heris; Department of Allergy and Clinical Immunology, Pediatric Hospital, Vahidi Street, Tabriz, Iran. Email: jah- madian76@yahoo.com Tel: 009841 35262280 oxygen saturation =94% in room air. After careful history taking and clinical examination, the pa- tient was diagnosed as gastritis. Intravenous line was ac- cessed and she was treated with 40 mg intravenous panto- prazole. 2 minutes after drug administration, the patient was symptomatic with hives, dyspnea and cyanosis and her blood pressure had decreased to 85/60 mmHg, heart rate increased to 101/minute, and oxygen saturation to 78% in room air. She was immediately treated as anaphylactic shock with nor- mal saline (30cc/kg), intramuscular epinephrine (0.3 mg), in- teravenous hydrocortisone (100 mg) and chlorpheniramin (4 mg). 6 lit/minute oxygen was administered via an oxygen mask. Gradually, her general condition improved and after 2 hours, the general condition completely was recovered. She was discharged after 12 hours. 3. Discussion Several complications such as headache, dizziness, joint pain, nausea, vomiting, abdominal pain, increased risk of stomach and pancreatic cancer, acute interstitial nephritis, diarrhea, risk of fractures, vitamin B 12 deficiency, hypomag- nesaemia, fever, hypertensive pneumonitis, liver damage, se- vere acute hepatitis, Kounis syndrome and thrombocytope- nia have been reported following usage of PPIs (1-10). Acute and delayed allergic reactions and systemic reactions have been reported in rare cases, even with oral doses of pump in- hibitor drugs (11-14). There are occasional cross-reactions This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: www.jemerg.com Gh. Faridaalaee & J. Ahmadian Heris 2 between different drugs in this group (14). Our search in literature shows that a few cases of anaphylaxis to PPI have been reported (14-16), and our case is another report of ana- phylaxis to pantoprazole. Anaphylatic reaction to PPIs is re- ported with both oral and IV routes of administration (17, 18). Hou-Chuan Lai et al. presented a case of anaphylaxis to IV pantoprazole in a 50 year-old male patient during general anesthesia, who was discharged after successful resuscita- tion (19). V. Vovolis et al. in a study in 2008 showed that skin test with PPIs could be considered as an accurate and simple method of evaluating the cross reaction between drugs of this group (20). Anaphylactic reaction to PPIs is rare but, like other causes of anaphylactic shock, it is life treatining. It seems that emer- gency phycisians should be aware of this problem and take care of the patients in case of this reaction happening. 3.1. Discussion The patient gave us informed consent to publish this presen- tation. 4. Appendix 4.1. Acknowledgements All the staff members of the emergency department of Imam Hospital are thanked for their cooperation throughout the study period. 4.2. Authors contribution All authors meet the standard criteria of authorship based on the recommendations of the international committee of medical journal editors. 4.3. Conflict of interest The authors declare that there is no conflict of interest. 4.4. Funding and support None. References 1. Richardson P, Hawkey CJ, Stack WA. Proton pump in- hibitors. Pharmacology and rationale for use in gastroin- testinal disorders. Drugs. 1998;56(3):307-35. 2. Atkins C, Maheswaran T, Rushbrook S, Kamath A. Lansoprazole-induced acute lung and liver injury: a case report. International journal of clinical pharmacology and therapeutics. 2014;52(12):1102-4. 3. Binnetoglu E, Akbal E, Sen H, Gunes F, Erbag G, Asik M, et al. Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding. Platelets. 2015;26(1):10-2. 4. 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Allergy. 2008;63(9):1251-2. 21. Natsch S, Vinks MH, Voogt AK, Mees EB, Meyboom RH. Anaphylactic reactions to proton-pump inhibitors. An- nals of Pharmacotherapy. 2000;34(4):474-6. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: www.jemerg.com Introduction Case presentation: Discussion Appendix References