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Anaphylactic reaction, anaphylactic shock and cross sensitivity: case report A 38-year-old man developed drug-induced anaphylactic reaction, anaphylactic shock and cross sensitivity during treatment with pantoprazole or ranitidine [not all times to reactions onsets stated]. The man with sedentary lifestyle presented with symptoms indicative of gastritis. After investigation, he was prescribed oral pantoprazole 40mg tablet once daily on empty stomach early morning, for a week, and advised lifestyle and diet modifications. He came back on the following day with facial flushing, erythematous macular skin rash and itching all over his body. These symptoms had appeared about 1 hour following ingestion of one pantoprazole 40mg tablet on empty stomach in the morning. He was hospitalised. The man was treated with pheniramine and kept under observation. His symptoms resolved in some time. A note was given to him saying that he had possibly suffered an allergic reaction (anaphylactic reaction) to pantoprazole and advised to inform any doctors of the same, prior to treatment in the future. He was discharged on syrup antacid, which he tolerated well. Around 2 months later, he presented in emergency department with similar complaints of erythematous skin rash, flushed face and itching all over the body after ingesting one pantoprazole 40mg tablet. Upon inquiry, he reported that he was prescribed pantoprazole 40mg tablet (different brand) once daily and ibuprofen for muscular pain in back by another general practitioner. This time the the trade name of pantoprazole tablet was different from the one prescribed 2 months previously; therefore, he did not realise that it was pantoprazole nor did he informed the doctor about his drug allergy. As a result, he ingested pantoprazole 40mg tablet (different brand) and developed allergic reaction (anaphylactic reaction).He did not take ibuprofen. He also complained of recurrent epigastric and the left-sided chest pain. He was treated with pheniramine. After thorough investigation antral gastritis was revealed. In order to find alternative treatment for gastritis, an oral challenge test was performed with ranitidine 150mg tablet. He developed similar allergic reaction with ranitidine also due to cross reactivity of pantoprazole and ranitidine. He and his wife were issued another note stating his allergy to pantoprazole tablet and ranitidine tablet. He was discharged on syrup antacid, which he tolerated well. Diet and lifestyle modifications were also suggested. About 3 months later, he presented to the emergency department again with severe gastritis, burning epigastric pain and several episodes of vomiting. This time the doctor on duty was different, and neither he nor his wife produced the note stating his drug allergy to ranitidine and pantoprazole. Additionally, they did not inform the doctor even verbally about his drug allergy. He was given IV pantoprazole 40mg injection and oral syrup antacid 20ml. Within 10 minutes of injection, he started feeling dizzy, had profuse sweating, flu