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Pantoprazole-induced recurrent anaphylactic shock
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Letters to the Editor
before initiation of stem cell transplantation, with death occurring only 6 months after presentation. This case serves to highlight the diversity in presentation of MCL in the GI tract, in addition to the requirement for further novel therapeutic strategies. Furthermore, to our knowledge, this is only the second reported case of early phase MCL selectively involving the terminal ileum. Funded by the Smith and Nephew Endoscopy Research Fellowship and BRET Medical Research Fellowship. D. P. Hurlstone, M.B., Ch.B., M.R.C.P. Gastroenterology and Liver Unit Royal Hallamshire Hospital Sheffield, United Kingdom
REFERENCES 1. Leonard JP, Schattner EJ, Coleman M. Biology and management of mantle cell lymphoma. Curr Opin Oncol 2001;13: 342–7. 2. Lai R, Medeiros LJ. Pathological diagnosis of mantle cell lymphoma. Clin Lymphoma 2000;1:207– 8. 3. Foss HD, Stein H. Pathology of intestinal lymphomas. Recent Results Cancer Res 2000;156:33– 41. 4. Kanehira K, Braylan RC, Lauwers GY. Early phase of intestinal mantle cell lymphoma: A report of two cases associated with advanced colonic adenocarcinoma. Mod Pathol 2001;14:811–7. 5. Terauchi S, Yamamoto K, Fujii H, et al. Mantle cell lymphoma of the rectum at an early stage: A case report. Hepatogastroenterology 2001;48:675–7. 6. Smir BN, Pulitzer DR. Multiple lymphomatous polyposis of the gut. A case with unusually widespread distribution. J Clin Gastroenterol 1994;19:139 – 42. 7. Maeda T, Yamada Y, Tawara M, et al. Successful treatment with a chimeric anti-CD20 monoclonal antibody (IDEC-C2B8, rituximab) for a patient with relapsed mantle cell lymphoma who developed a human anti-chimeric antibody. Int J Hematol 2001;74:70 –5. 8. Clavio M, Quintino S, Venturino C, et al. Lymphoplasmacytic lymphoma/immunocytoma: Towards a disease targeted treatment? J Exp Clin Cancer Res 2001;20:351– 8. 9. Cohen BJ, Moskowitz C, Straus D, et al. Cyclophosphamide/ fludarabine (CF) is active in the treatment of mantle cell lymphoma. Leuk Lymphoma 2001;42:1015–22. Reprint requests and correspondence: D. P. Hurlstone, M.D., 40 Ranby Road, Hunters Bar, Sheffield, South Yorkshire S11 7AJ, United Kingdom. Received Jan. 7, 2002; accepted Jan. 10, 2002.
Pantoprazole-Induced Recurrent Anaphylactic Shock TO THE EDITOR: Several anaphylactic reactions induced by proton pump inhibitor have been reported in a few case reports (1). We report one case of recurrent anaphylactic shock induced by pantoprazole. A 42-yr-old male dental surgeon was admitted to the intensive care unit for anaphylactic shock: low systolic
AJG – Vol. 97, No. 6, 2002
Table 1. Pantoprazole-Related Adverse Events Event Most commonly Headache Diarrhea Flatulence Abdominal pain Rash Eructation Insomnia Hyperglycemia Vomiting Sporadically Belching Shoulder pain Constipation Liver enzyme elevation Plasma lipoprotein elevation Peripheral edema Arthralgia Severe reactions Optic neuropathy Anterior ischemic optic neuropathy Pancreatitis Erythema multiforme Steven-Johnson syndrome Toxic epidermal necrolysis Anaphylactic shock Multiple organ failure
Incidence 6 4 2 1 ⬍1 1 ⬍1 1 2.3
Refs. Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Dettmer et al. (5) van Rensburg et al. (6) Meneghelli et al. (7) Corinaldesi et al. (8) Mossner et al. (9) Rehner et al. (10) Brunner and Harke (11) Chen et al. (12) Protonix (3) Protonix (3) Protonix (3) Jungnickel (13) Jungnickel (13) Jungnickel (13) Natsch et al. (1) Yusoff et al. (4)
blood pressure at 60 mm Hg and tachycardia at 130 pulsations/min with syncope, mucosal hypersecretion, conjunctival hyperemia, and cutaneous erythema. He had presented eight similar episodes with good outcomes after symptomatic treatment in the past 3 months without diagnosis despite a large hospital checkup. He had no special medical history except a reflux esophagitis automedicated by lanzoprazole or pantoprazole. All medications were stopped at admission. Initial biology noted only a hypereosinophilia at 2000/mm3. Special hormonal investigations were normal. No parasital infection was found. The allergic etiological mechanism was evoked. Pantoprazole and lanzoprazole were reintroduced successively under strict medical supervision in the intensive care unit. No manifestation was observed after lanzoprazole intake. But within a few minutes of pantoprazole intake, he developed malaise, generalized pruritus and urticaria, diffuse sweating, and a swollen tongue and eyes, and his blood pressure decreased to 60/40 mm Hg. The patient recovered with discontinuation of pantoprazole and supportive care. The most common adverse events considered to be related to pantoprazole treatment included headache (2%), diarrhea (2%), and flatulence with abdominal pain (1%) (2, 3) (Table 1). Yussof et al. (4) reported a case of multiple organ failure with an onset of symptoms 2 days after pantoprazole was started at 40 mg daily. Natsch et al. (1) reported the first case of anaphylactic reaction induced by
AJG – June, 2002
Letters to the Editor
pantoprazole. In our patient, because of a positive reintroduction test, the reaction is classified as anaphylactic shock to pantoprazole. Of course, reintroduction of pantoprazole (with patient consent) was dangerous, but we thought it had to be done to clarify the diagnosis of this ninth anaphylactic shock of unknown origin. The Uppsala Monitoring Center has received a total of 42 reports of anaphylactic reactions or anaphylactic shock in association with proton pump inhibitors (12, 27, and three cases with lanzoprazole, omeprazole, and pantoprazole, respectively). Proton pump inhibitors are a rare cause of anaphylactic reactions such as shock. More precise information is needed, and health care professionals need to be aware of this possibility when prescribing these agents. Laurence Fardet, Hassane Izzedine, Magali Ciroldi, Kiet Phong Tiev, Jean Cabane,
M.D. M.D. M.D. M.D. M.D.
Department of Nephrology Pitie Salpetriere Hospital Department of Internal Medicine Saint Antoine Hospital Paris, France
REFERENCES 1. Natsch S, Vinks MH, Voogt AK, et al. Anaphylactic reactions to proton-pump inhibitors. Ann Pharmacother 2000;34: 474 – 6. 2. Pantoprazole (Protonix). Med Lett Drugs Ther 2000;42(1083): 65– 6. 3. Protonix威. Philadelphia: Wyeth-Ayerst Laboratories, 2000 (package insert).
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4. Yusoff IF, Nairn P, Morgan CA. Multiple organ failure related to pantoprazole. Aust N Z J Med 1999;29:833– 4. 5. Dettmer A, Vogt R, Sielaff F, et al. Pantoprazole 20 mg is effective for relief of symptoms and healing of lesions in mild reflux oesophagitis. Aliment Pharmacol Ther 1998;12:865–72. 6. van Rensburg CJ, Honiball PJ, Grundling HD, et al. Efficacy and tolerability of pantoprazole 40 mg versus 80 mg in patients with reflux oesophagitis. Aliment Pharmacol Ther 1996; 10:397– 401. 7. Meneghelli UG, Zaterka S, de Paula Castro L, et al. Pantoprazole versus ranitidine in the treatment of duodenal ulcer: A multicenter study in Brazil. Am J Gastroenterol 2000;95:62– 6. 8. Corinaldesi R, Valentini M, Belaiche J, et al. Pantoprazole and omeprazole in the treatment of reflux oesophagitis: A European multicentre study. Aliment Pharmacol Ther 1995;9:667– 71. 9. Mossner J, Holscher AH, Herz R, Schneider A. A doubleblind study of pantoprazole and omeprazole in the treatment of reflux oesophagitis: A multicentre trial. Aliment Pharmacol Ther 1995;9:321– 6. 10. Rehner M, Rohner HG, Schepp W. Comparison of pantoprazole versus omeprazole in the treatment of acute duodenal ulceration—a multicentre study. Aliment Pharmacol Ther 1995;9:411– 6. 11. Brunner G, Harke U. Long-term therapy with pantoprazole in patients with peptic ulceration resistant to extended high-dose ranitidine treatment. Aliment Pharmacol Ther 1994;8(suppl 1):59 – 64. 12. Chen TS, Chang FY, Ng WW, et al. The efficacy of the third pump inhibitor—pantoprazole—in the short-term treatment of Chinese patients with duodenal ulcer. Hepatogastroenterology 1999;46:2372– 8. 13. Jungnickel PW. Pantoprazole: A new proton pump inhibitor. Clin Ther 2000;22:1268 –93.
Reprint requests and correspondence: Hassane Izzedine, Department of Nephrology, Pitie Salpetriere Hospital, 83 Boulevard de l’Hopital, 75013 Paris, France. Received Jan. 8, 2002; accepted Jan. 10, 2002.
Letters to the Editor
before initiation of stem cell transplantation, with death occurring only 6 months after presentation. This case serves to highlight the diversity in presentation of MCL in the GI tract, in addition to the requirement for further novel therapeutic strategies. Furthermore, to our knowledge, this is only the second reported case of early phase MCL selectively involving the terminal ileum. Funded by the Smith and Nephew Endoscopy Research Fellowship and BRET Medical Research Fellowship. D. P. Hurlstone, M.B., Ch.B., M.R.C.P. Gastroenterology and Liver Unit Royal Hallamshire Hospital Sheffield, United Kingdom
REFERENCES 1. Leonard JP, Schattner EJ, Coleman M. Biology and management of mantle cell lymphoma. Curr Opin Oncol 2001;13: 342–7. 2. Lai R, Medeiros LJ. Pathological diagnosis of mantle cell lymphoma. Clin Lymphoma 2000;1:207– 8. 3. Foss HD, Stein H. Pathology of intestinal lymphomas. Recent Results Cancer Res 2000;156:33– 41. 4. Kanehira K, Braylan RC, Lauwers GY. Early phase of intestinal mantle cell lymphoma: A report of two cases associated with advanced colonic adenocarcinoma. Mod Pathol 2001;14:811–7. 5. Terauchi S, Yamamoto K, Fujii H, et al. Mantle cell lymphoma of the rectum at an early stage: A case report. Hepatogastroenterology 2001;48:675–7. 6. Smir BN, Pulitzer DR. Multiple lymphomatous polyposis of the gut. A case with unusually widespread distribution. J Clin Gastroenterol 1994;19:139 – 42. 7. Maeda T, Yamada Y, Tawara M, et al. Successful treatment with a chimeric anti-CD20 monoclonal antibody (IDEC-C2B8, rituximab) for a patient with relapsed mantle cell lymphoma who developed a human anti-chimeric antibody. Int J Hematol 2001;74:70 –5. 8. Clavio M, Quintino S, Venturino C, et al. Lymphoplasmacytic lymphoma/immunocytoma: Towards a disease targeted treatment? J Exp Clin Cancer Res 2001;20:351– 8. 9. Cohen BJ, Moskowitz C, Straus D, et al. Cyclophosphamide/ fludarabine (CF) is active in the treatment of mantle cell lymphoma. Leuk Lymphoma 2001;42:1015–22. Reprint requests and correspondence: D. P. Hurlstone, M.D., 40 Ranby Road, Hunters Bar, Sheffield, South Yorkshire S11 7AJ, United Kingdom. Received Jan. 7, 2002; accepted Jan. 10, 2002.
Pantoprazole-Induced Recurrent Anaphylactic Shock TO THE EDITOR: Several anaphylactic reactions induced by proton pump inhibitor have been reported in a few case reports (1). We report one case of recurrent anaphylactic shock induced by pantoprazole. A 42-yr-old male dental surgeon was admitted to the intensive care unit for anaphylactic shock: low systolic
AJG – Vol. 97, No. 6, 2002
Table 1. Pantoprazole-Related Adverse Events Event Most commonly Headache Diarrhea Flatulence Abdominal pain Rash Eructation Insomnia Hyperglycemia Vomiting Sporadically Belching Shoulder pain Constipation Liver enzyme elevation Plasma lipoprotein elevation Peripheral edema Arthralgia Severe reactions Optic neuropathy Anterior ischemic optic neuropathy Pancreatitis Erythema multiforme Steven-Johnson syndrome Toxic epidermal necrolysis Anaphylactic shock Multiple organ failure
Incidence 6 4 2 1 ⬍1 1 ⬍1 1 2.3
Refs. Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Protonix (3) Dettmer et al. (5) van Rensburg et al. (6) Meneghelli et al. (7) Corinaldesi et al. (8) Mossner et al. (9) Rehner et al. (10) Brunner and Harke (11) Chen et al. (12) Protonix (3) Protonix (3) Protonix (3) Jungnickel (13) Jungnickel (13) Jungnickel (13) Natsch et al. (1) Yusoff et al. (4)
blood pressure at 60 mm Hg and tachycardia at 130 pulsations/min with syncope, mucosal hypersecretion, conjunctival hyperemia, and cutaneous erythema. He had presented eight similar episodes with good outcomes after symptomatic treatment in the past 3 months without diagnosis despite a large hospital checkup. He had no special medical history except a reflux esophagitis automedicated by lanzoprazole or pantoprazole. All medications were stopped at admission. Initial biology noted only a hypereosinophilia at 2000/mm3. Special hormonal investigations were normal. No parasital infection was found. The allergic etiological mechanism was evoked. Pantoprazole and lanzoprazole were reintroduced successively under strict medical supervision in the intensive care unit. No manifestation was observed after lanzoprazole intake. But within a few minutes of pantoprazole intake, he developed malaise, generalized pruritus and urticaria, diffuse sweating, and a swollen tongue and eyes, and his blood pressure decreased to 60/40 mm Hg. The patient recovered with discontinuation of pantoprazole and supportive care. The most common adverse events considered to be related to pantoprazole treatment included headache (2%), diarrhea (2%), and flatulence with abdominal pain (1%) (2, 3) (Table 1). Yussof et al. (4) reported a case of multiple organ failure with an onset of symptoms 2 days after pantoprazole was started at 40 mg daily. Natsch et al. (1) reported the first case of anaphylactic reaction induced by
AJG – June, 2002
Letters to the Editor
pantoprazole. In our patient, because of a positive reintroduction test, the reaction is classified as anaphylactic shock to pantoprazole. Of course, reintroduction of pantoprazole (with patient consent) was dangerous, but we thought it had to be done to clarify the diagnosis of this ninth anaphylactic shock of unknown origin. The Uppsala Monitoring Center has received a total of 42 reports of anaphylactic reactions or anaphylactic shock in association with proton pump inhibitors (12, 27, and three cases with lanzoprazole, omeprazole, and pantoprazole, respectively). Proton pump inhibitors are a rare cause of anaphylactic reactions such as shock. More precise information is needed, and health care professionals need to be aware of this possibility when prescribing these agents. Laurence Fardet, Hassane Izzedine, Magali Ciroldi, Kiet Phong Tiev, Jean Cabane,
M.D. M.D. M.D. M.D. M.D.
Department of Nephrology Pitie Salpetriere Hospital Department of Internal Medicine Saint Antoine Hospital Paris, France
REFERENCES 1. Natsch S, Vinks MH, Voogt AK, et al. Anaphylactic reactions to proton-pump inhibitors. Ann Pharmacother 2000;34: 474 – 6. 2. Pantoprazole (Protonix). Med Lett Drugs Ther 2000;42(1083): 65– 6. 3. Protonix威. Philadelphia: Wyeth-Ayerst Laboratories, 2000 (package insert).
1579
4. Yusoff IF, Nairn P, Morgan CA. Multiple organ failure related to pantoprazole. Aust N Z J Med 1999;29:833– 4. 5. Dettmer A, Vogt R, Sielaff F, et al. Pantoprazole 20 mg is effective for relief of symptoms and healing of lesions in mild reflux oesophagitis. Aliment Pharmacol Ther 1998;12:865–72. 6. van Rensburg CJ, Honiball PJ, Grundling HD, et al. Efficacy and tolerability of pantoprazole 40 mg versus 80 mg in patients with reflux oesophagitis. Aliment Pharmacol Ther 1996; 10:397– 401. 7. Meneghelli UG, Zaterka S, de Paula Castro L, et al. Pantoprazole versus ranitidine in the treatment of duodenal ulcer: A multicenter study in Brazil. Am J Gastroenterol 2000;95:62– 6. 8. Corinaldesi R, Valentini M, Belaiche J, et al. Pantoprazole and omeprazole in the treatment of reflux oesophagitis: A European multicentre study. Aliment Pharmacol Ther 1995;9:667– 71. 9. Mossner J, Holscher AH, Herz R, Schneider A. A doubleblind study of pantoprazole and omeprazole in the treatment of reflux oesophagitis: A multicentre trial. Aliment Pharmacol Ther 1995;9:321– 6. 10. Rehner M, Rohner HG, Schepp W. Comparison of pantoprazole versus omeprazole in the treatment of acute duodenal ulceration—a multicentre study. Aliment Pharmacol Ther 1995;9:411– 6. 11. Brunner G, Harke U. Long-term therapy with pantoprazole in patients with peptic ulceration resistant to extended high-dose ranitidine treatment. Aliment Pharmacol Ther 1994;8(suppl 1):59 – 64. 12. Chen TS, Chang FY, Ng WW, et al. The efficacy of the third pump inhibitor—pantoprazole—in the short-term treatment of Chinese patients with duodenal ulcer. Hepatogastroenterology 1999;46:2372– 8. 13. Jungnickel PW. Pantoprazole: A new proton pump inhibitor. Clin Ther 2000;22:1268 –93.
Reprint requests and correspondence: Hassane Izzedine, Department of Nephrology, Pitie Salpetriere Hospital, 83 Boulevard de l’Hopital, 75013 Paris, France. Received Jan. 8, 2002; accepted Jan. 10, 2002.