Recurred pantoprazole anaphylaxis: a rare case report from Nepal.

Introduction: Pantoprazole is a commonly used proton pump inhibitor (PPI) with rare incidents of dreaded and life-threatening complications. Case presentation: A 57-year-old woman presented to the emergency department with an acute onset of generalized rashes and chest tightness after intake of an over-the-counter oral pantoprazole and domperidone combination tablet. She later presented again with a headache for which she was administered intravenous acetaminophen and pantoprazole, following which she developed severe itching, hives, and shortness of breath with hypotension. She was managed with 0.5 ml of adrenaline (1:1000) intramuscularly and supportive measures after which she was stabilized and discharged. Discussion: Drug reactions and treatment history to oral pantoprazole are poorly recorded and explored due to large over-the-counter sales, and thus can be missed. Physicians should be aware of cross-hypersensitivity among PPIs, and a safe alternative should be decided after a skin allergy workup. Conclusion: It is necessary to extensively extract drug and allergy history, and even the most commonly used drugs with rarely any side effects should also be used cautiously.