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Drug hypersensitivity or anaphylaxis: 2 case reports A 42-year-old woman developed a hypersensitivity reaction after taking ranitidine for dyspepsia and an 80-year-old man developed an anaphylactic reaction to cimetidine administered for urticaria. In both patients, cross-reactivity with other histamine H2-receptor antagonists was assessed. The woman, who had a history of dermographism, had developed sneezing, swelling of the eyelids and dyspnoea 30 minutes after taking a single tablet of ranitidine 150mg [Zantac]. She experienced the same allergic reaction immediately after taking ranitidine 1 week after the first dose. She presented to a clinic 1 month after the first hypersensitivity episode. An oral challenge with ranitidine 75mg [Curan] provoked no response. However, 30 minutes after receiving ranitidine 150mg, she experienced generalised pruritus and rhinorrhoea, and urticaria was observed in her ears and axilla. An oral challenge with famotidine [Gaster] provoked a positive response. A ranitidine-induced hypersensitivity reaction with possible famotidine cross-reactivity was diagnosed. The man, who had a history of angina pectoris, was transferred to an emergency room with dizziness and chest discomfort. His BP was 60/40mm Hg and wheezing was noted. He appeared confused, his face was swollen, and severe generalised urticaria was observed. He recovered following administration of epinephrine [adrenaline], chlorphenamine and corticosteroids. It was ascertained that, 10 minutes prior to symptom-onset, he had received cimetidine [route and dose not stated], chlorphenamine and paracetamol [acetaminophen] for mild urticaria. He developed severe generalised urticaria, chest discomfort, dizziness, dyspnoea and facial swelling immediately after receiving these medications. He recovered and underwent intradermal skin tests. Ranitidine and famotidine began to provoke a response at 1:10 dilution in normal saline, and cimetidine at 1:100 dilution. A cimetidine-induced anaphylaxis with possible famotidine and ranitidine crossreactivity was diagnosed. Song W-J, et al. Two cases of H2-receptor antagonist hypersensitivity and crossreactivity. Allergy, Asthma and Immunology Research 3: 128-131, No. 2, Apr 2011. Available from: URL: http://dx.doi.org/10.4168/aair.2011.3.2.128 - South 803053640 Korea

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Reactions 7 May 2011 No. 1350