Two Cases of H2-Receptor Antagonist Hypersensitivity and Cross-Reactivity

H2-receptor antagonists, such as cimetidine, ranitidine and famotidine, are some of the most commonly prescribed medications for gastric acid-related disorders. These compounds are generally well-tolerated and anaphylactic reactions to them are rare. Here, we report two cases of H2-receptor antagonist-induced anaphylactic reactions: the first presented with sudden dyspnea, sneezing, urticaria, and swelling of the eyelids after ranitidine intake. The second presented with sudden severe urticaria, facial swelling, chest discomfort, dizziness, and hypotension. Possible cross-reactivity with other H2-receptor antagonists was assessed by oral challenge and skin tests. To date, only a few reports addressing cross-reactivity among H2-receptor antagonists have been published. We review the literature and summarize the data available on drug cross-reactivity in H2-receptor antagonist hypersensitivity.

Profilaxia dos sangramentos gastrintestinais em Medicina de Urgência / Prophylaxis of gastrointestinal bleeding in Emergency Medicine

JUSTIFICATIVA E OBJETIVOS: O sangramento gastrintestinal agudo é uma condição comum que, geralmente, demanda admissão em unidades de emergência, além de representar também complicação frequente naqueles pacientes previamente internados em unidades de terapia intensiva (UTI). A hemorragia digestiva alta (HDA) possui incidência anual de 50 a 150 para cada 100.000 habitantes, ocorrendo duas vezes mais em homens e aumenta com a idade; a hemorragia digestiva baixa (HDB) apresenta incidência de 20,5 a 27 para cada 100.000 habitantes e a úlcera por estresse é clinicamente evidente em 15% dos casos sem profilaxia e em 1,5% a 8% daqueles com profilaxia. Neste cenário, este estudo teve como objetivo apresentar os métodos profiláticos primários e secundários utilizados nos sangramentos gastrintestinais em Medicina de urgência, bem como suas indicações atuais baseadas em evidências. CONTEÚDO: Revisão narrativa com período delimitado entre os anos de 1970 a 2010, com busca de artigos disponíveis e resumos em bases de dados como Scielo, LILACS, Medline, Pubmed, Sumsearch, National Guideline Clearinghouse, assim como livros relacionados à área de Medicina intensiva e emergência. CONCLUSÃO: No manuseio das úlceras por estresse são utilizados os antagonistas do receptor H2 (AR2H) como método de escolha, seguidos do sucralfato, antiácidos e inibidores da bomba de prótons (IBP). Nos sangramentos gastrintestinais utilizam-se preferencialmente os IBP e nas roturas de varizes esofágicas, escleroterapia e ligaduras elásticas. Nestes casos, o ressangramento pode ser prevenido com betabloqueadores e nitrato.

BACKGROUND AND OBJECTIVES: Acute gastrointestinal bleeding is a common condition that usually requires admission to the emergency room and also represents a complication in patients previously hospitalized in intensive care units (ICU). The upper gastrointestinal bleeding (UGIB) has an annual incidence of 50-150 per 100,000 inhabitants, occurring twice as often in men and increases with age, the lower gastrointestinal bleeding presents incidence from 20.5 to 27 per 100,000 and the stress ulcer is clinically evident in 15% of cases without prophylaxis and 1.5% to 8% of those with prophylaxis. In this scenario, this paper had as objective to present the primary and secondary prophylactic methods to control gastrointestinal bleedings in Emergency Medicine, as well as your indications based on the best actual evidences. CONTENTS: Narrative bounded between the years 1970 to 2010, with search articles and abstracts available on databases such as Scielo, LILACS, Medline, Pubmed, Sumsearch, National Guideline Clearinghouse, as well as books related to area of critical care medicine and emergency. CONCLUSION: In the management of stress ulcers are used H2 receptor antagonists (AR2H) as a method of choice, followed by sucralfate, antacids and proton pump inhibitors (PPIs). In gastrointestinal bleeding are used preferentially IBPs and in ruptures of esophageal varices, sclerotherapy and elastic bandages. In these cases, rebleeding can be prevented with beta-blockers and nitrates.

The Comparative Study on the Efficacy of Ranitidine and Rabeprazole in Reflux Laryngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reflux laryngitis gives rise to inflammatory change in the pharyngolaryngeal tissue with various otolaryngologic and respiratory symptoms. Histamine H2 receptor antagonists and H(+)-K(+)-Exchanging ATPase are currently used as therapeutic medications. However, the efficacy of those two drugs on reflux laryngitis has never been proven yet. Therefore, we intended to analyze and compare the efficacy of the two drugs on reflux laryngitis. MATERIALS AND METHOD: Among the patients who had visited the Department of Otolaryngology, those with the total score of greater than 6 and having more than 2 symptoms that score greater than 2, had undergone laryngoscopy. Of these, the patients who had shown greater than 7 on the Belafsky's Reflux Finding Score (RFS) were studied. The RAN (Ranitidine) group (59 subjects) with Ranitidine administered and RAB (Rabeprazole)group (66 subjects) with Rabeprazole were followed up for 12 weeks, and then the efficacy of each drug was evaluated at 2nd, 4th, and 12th week. Then, the Symptom Score Improvement (SSI) and RFS were compared and analyzed. RESULTS: In comparison the RAN group that had Histamine H2 receptor antagonists and prokinetic agents administered to the RAB group that had H(+)-K(+)-Exchanging ATPase and prokinetic agents administered for the improvement of symptoms caused by reflux laryngitis, no difference was observed till after the first 2 weeks. On the evaluation at 4th and 12th week, statistically higher therapeutic efficacy was shown to a great extent in the RAB group. The findings of laryngoscopy at the 12th week also showed higher therapeutic efficacy in the RAB group. In comparison of symptoms between the groups, there were significant differences in pharyngolaryngeal foreign body sense and chronic throat clearing, and laryngeal edema and injection as well. CONCLUSION: For therapy of reflux laryngitis patients with moderately severe symtpoms, the use of H(+)-K(+)-Exchanging ATPase and prokinetic agents were superior in improving symptoms and clinicopathologic findings of larynx than Histamine H2 receptor antagonists and prokinetic agents.