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Can H2 -receptor upregulation and raised histamine explain an anaphylactoid reaction on cessation of ranitidine in a 19-year-old female? A case report

Allen, Susan J.; Dixon, C. Jane; Chazot, Paul L.

Can H2 -receptor upregulation and raised histamine explain an anaphylactoid reaction on cessation of ranitidine in a 19-year-old female? A case report Thumbnail


Authors

Susan J. Allen

C. Jane Dixon



Abstract

The anaphylactoid reaction described follows cessation of ranitidine in a 19‐year‐old female with the disease cluster: mast cell activation syndrome, hypermobile Ehlers‐Danlos syndrome and postural tachycardia syndrome. Anaphylaxis can give wide‐ranging symptoms from rhinorrhoea and urticaria to tachycardia and system‐wide, life‐threatening, anaphylactic shock. Individuals with a disorder of mast cell activation can experience many such symptoms. H2 receptor antagonists, such as ranitidine, are commonly prescribed in this population. A mechanism for the reaction is proposed in the context of ranitidine, as an inverse agonist, causing upregulation of H2 histamine receptors and raised histamine levels due to enzyme induction. This effect, following extended and/or high antihistamine dosing, may have implications for other individuals with a disorder of mast cell activation, such as mastocytosis or mast cell activation syndrome. There are potential policy and patient guidance implications for primary and secondary care with respect to cessation of H2 antagonists.

Citation

Allen, S. J., Dixon, C. J., & Chazot, P. L. (2018). Can H2 -receptor upregulation and raised histamine explain an anaphylactoid reaction on cessation of ranitidine in a 19-year-old female? A case report. British Journal of Clinical Pharmacology, 84(7), 1611-1616. https://doi.org/10.1111/bcp.13578

Journal Article Type Article
Acceptance Date Feb 27, 2018
Online Publication Date Apr 18, 2018
Publication Date Jul 1, 2018
Deposit Date Apr 19, 2018
Publicly Available Date Mar 29, 2024
Journal British Journal of Clinical Pharmacology
Print ISSN 0306-5251
Electronic ISSN 1365-2125
Publisher British Pharmacological Society
Peer Reviewed Peer Reviewed
Volume 84
Issue 7
Pages 1611-1616
DOI https://doi.org/10.1111/bcp.13578

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Accepted Journal Article (750 Kb)
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Copyright Statement
This is the accepted version of the following article: Allen, Susan J., Dixon, C. Jane & Chazot, Paul L. (2018). Can H2 -receptor upregulation and raised histamine explain an anaphylactoid reaction on cessation of ranitidine in a 19-year-old female? A case report. British Journal of Clinical Pharmacology 84(7): 1611-1616 which has been published in final form at https://doi.org/10.1111/bcp.13578. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.





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