Anaphylaxis following intravenous ranitidine: A rare adverse reaction of a common drug
This is case report of a 60-year-old male patient who was brought to the emergency department in drowsy state with skin eruptions over the chest and abdomen. Prior to the present episode the patient had severe epigastric discomfort for which the doctor gave him injection ranitidine 50 mg (Peptac 50 mg/2 ml, containing phenol 0.5% as preservative). Within minutes of the injection, the patient developed above symptoms. There was no history of intake of any other medication. He had no other medical illness. The patient gave positive history of allergy to amoxicillin.\nOn examination, he was found to be drowsy and had edema of the face. Pulse rate was 100 beats/min, blood pressure - 80/40 mmHg, temperature - 36.8°C, respiratory rate - 26/min and oxygen saturation of 83% by pulse oximetry. Wheals were present all over the chest and abdomen suggestive of urticaria. Cardiac and respiratory system examination was unremarkable.\nInvestigations: Hemoglobin: 16.7 g %, total leukocyte count: 11,500, neutrophils - 80%, lymphocytes 14%, monocytes 2%, eosinophil's 4%, random blood sugar: 102 mg/dl, urea: 30 mg/dl, creatinine: 1.5 mg/dl, serum sodium: 141 mEq/l, serum potassium: 3.9 mEq/l, serum chloride: 102 mmol/l, electrocardiogram was suggestive of right bundle branch block with left axis deviation.\nBased on history and findings, the patient was diagnosed as a case of anaphylaxis subsequent to injection ranitidine. He was administered intravenous adrenaline 0.5 mg, hydrocortisone 100 mg and pheniramine 25 mg. He did not require ventilatory support and responded to the treatment. His vitals improved gradually and he was discharged after 3 days. Subsequent test revealed a raised immunoglobulin E (IgE) levels (1658 IU/ml).\nIntradermal test with ranitidine in dilution of 1:1000 was found to be negative. However, patient did not give consent for further testing due to obvious reasons.\nA lucid temporal relationship was observed between the administration of the drug (ranitidine) and the commencement of symptoms. Using Naranjo probability scale the relationship between the drug and the event was categorized as probable.[]