Hypersensitivity reaction to ranitidine: Two case reports and review of the use of H2-antagonists in prophylactic treatment against hypersensitivity reactions

Early clinical development of paclitaxel was complicated by life-threatening hypersensitivity reactions (HSRs) manifested by hypotension, dyspnoea, angiooedema and urticaria. Prolongation of paclitaxel infusion time and empiric pretreatment with steroids, H1-antagonists and H 2-antagonists were introduced based on similar regimens that had proven useful in preventing reactions to radiographic contrast media. This regimen has led to a reduction in incidence of HSRs and successful retreatment of patients with prior HSRs to paclitaxel. However, the actual benefit of an H2-antagonist, such as ranitidine, in the premedication regimen is questionable and may even increase HSRs. On the basis of two case reports and review of literature data, the use of ranitidine in prophylaxis of HSRs should be revised and carefully evaluated in clinical practice. Randomized controlled clinical trials need to be performed to address the benefit of H 2-antagonists in preventing HSRs.