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Anaphylaxis and lack of drug effect: case report A 75-year-old man developed fatal anaphylaxis during prophylactic treatment with ranitidine for stress ulcer. He exhibited lack of drug effect during treatment with hydrocortisone for anaphylaxis. The man was hospitalised due to fever and right upper quadrant pain for one day. Three months prior, he underwent a cholecystectomy. On admission his consciousness level was clear. Various examinations were performed and a provisional diagnosis of acute cholangitis was made. Eight hours prior to admission at ward, he started receiving treatment with cefoxitin, and it was uneventful. On admission, he started receiving treatment with IV ranitidine injection [Zantac] in slow push mode [dosage not stated] as a prophylactic treatment of stress ulcer, despite of low risk of gastrointestinal bleeding. Within 10 seconds of receiving injection, he complained about itchiness all over his body with facial redness. Subsequently, he experienced shortness of breath and cold sweating. Thereafter, his consciousness level deteriorated and he developed cardio-respiratory collapse. The man was intubated and also received cardiopulmonary cerebral resuscitation (CPCR) along with adequate doses of hydrocortisone and an unspecified anti-histamine. Thirty minutes later, he died, as he did not survive the CPCR. His blood culture showed growth of E. coli, which was significant with provisional diagnosis of acute cholangitis. Based on his past medical records, he did not have a history of drug allergy or any atopic predisposition. One and a half year prior during cholecystectomy, he received unspecified proton pump inhibitor; however, there was no record of allergy. Author comment: "Fatal deaths from ranitidine-associated anaphylaxis was rare" Chuah YY, et al. Fatal anaphylaxis of ranitidine injection : have we not learnt the lesson yet?. Acta Gastroenterologica Belgica 82: 449-450, No. 3, Jul 2019. Available from: URL: http://www.acta-gastroenterologica.be/ index.php?page=shop.product_details&flypage=flypage.tpl&product_id=2854&category_id=828&option=com_virtuemart&Itemid=54 803431424 - Taiwan

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Editorial comment: Details of this case report have previously been published [see Reactions 1748 p447; 803384117].

0114-9954/19/1777-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved

Reactions 2 Nov 2019 No. 1777