Ranitidine

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Anaphylaxis: case report An adult man [exact age at reaction onset not stated] developed anaphylaxis during treatment with ranitidine for diffuse/intense epigastric pain. The man presented at the age of 35 years to the allergy specialist for evaluation of persistent allergic rhinitis to pollen. During the allergy history, he mentioned that the allergic rhinitis had started 6 years prior to the presentation. In this interval of time, during an episode of exacerbation of rhinitis, he had diffuse epigastric pain, for which a gastroenterologist had given ranitidine 300 mg/day for 2 weeks [route not stated]. On the second day of ranitidine therapy, two hours following the administration of ranitidine, he had angioedema of the face and generalised urticaria. He also reported that he had previous exposure to ranitidine for acute gastritis; however, at that time, he had tolerated ranitidine therapy without side effects. He reported that due to angioedema of the face and generalised urticaria, his gastroenterologist had replaced ranitidine by omeprazole. He had tolerated omeprazole without any side effect and allergy evaluation was not performed at that time. He also reported that 8 months after the appearance of angioedema of the face and generalised urticaria, he had intense epigastric pain. As a result, he had self-administered ranitidine 150 mg/day [route not stated]. Within first hour of administration, he had angioedema of the lips, eyes and face, as well as, generalised urticaria. Consequently, he had self-administered a H1 antihistaminic drug [specific drug not stated] and stopped ranitidine. Within 12h of ranitidine discontinuation, his angioedema and generalised urticaria subsided. He further reported that in the following year, at the beginning of grass pollen season, he showed specific symptoms for allergic rhinitis that were not reduced by desloratadine 5 mg/day, as in the previous seasons. He reported that the rhinitis symptoms occurred daily, which had affected his quality of life and his sleep. He could no longer perform his activity outdoors during the last 5 days before the presentation. As a result, he decided to ask help from an allergist. The allergy specialist decided to treat his rhinitis symptoms with levocetirizine and fluticasone furoate until the end of grass pollen season and to re-evaluate the atopic status and a possible hypersensitivity reaction induced by ranitidine. The skin prick test was postponed until the end of summer. It was also recommended to avoid the administration of ranitidine and other H2 receptors antagonists until the final diagnosis was established. The immediate and during pollen season evolution was good, with rhinitis symptoms controlled in few days of the treatment. After avoiding ranitidine, he did not have urticaria or angioedema. He returned at the end of treatment (i.e. at the end of levocetirizine and fluticasone furoate therapy) to perform the skin prick test. The skin prick test using ranitidine was performed and was found to be positive after 15 minutes. The