ArticleFrontiers in allergy2026
Case Report: First report of vonoprazan-associated severe Gly m 4-mediated PFAS anaphylaxis in the era of potent acid suppression.
Article in Frontiers in allergy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pollen-food allergy syndrome (PFAS) usually causes localized oral symptoms through cross-reactivity between pollen allergens and plant-derived foods. However, the soybean PR-10 allergen Gly m 4 can provoke systemic reactions, including anaphylaxis. Proton pump inhibitors (PPIs) are recognized in PFAS consensus statements as potential cofactors, although acid suppression is not established as a major cofactor for food-induced anaphylaxis overall. Increasingly prescribed potassium-competitive acid blockers (P-CABs), including vonoprazan, provide potent and sustained acid suppression beyond conventional PPIs. To our knowledge, severe PR-10-related PFAS temporally associated with P-CAB therapy has not been previously reported. Case presentation: A 59-year-old woman had experienced mild oral allergy syndrome-like symptoms, including lip swelling, after soy milk ingestion, while tolerating other soybean products. Two weeks after starting vonoprazan 20 mg for gastroesophageal reflux disease, she developed generalized urticaria, throat discomfort, and dyspnea after dinner containing inadequately cooked soybean sprouts, requiring epinephrine. Three months later, within 15 min after eating ramen containing inadequately cooked soybean sprouts, she developed generalized urticaria and dyspnea, requiring hospitalization and epinephrine. Component-resolved testing showed positive specific IgE to Gly m 4, whereas crude soybean extract, Conclusion: To our knowledge, this is the first report of severe Gly m 4-mediated PFAS anaphylaxis temporally associated with vonoprazan use. Potent P-CAB-mediated acid suppression may theoretically reduce gastric degradation of labile PR-10 allergens and increase systemic exposure to immunologically active Gly m 4, although causality was not proven because oral food challenge with and without vonoprazan was not performed. These findings suggest that, in PR-10-related PFAS, medication review and anticipatory counseling regarding potent acid suppression, particularly P-CAB therapy, may be important in patients with PFAS, even when previous symptoms have been limited to mild oral reactions.
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