Fatal anaphylaxis of ranitidine injection : have we not learnt the lesson yet?

A 75-year-old man was admitted with complaints of fever and right upper quadrant pain for one day. He underwent a cholecystectomy three month ago. His conscious level was clear (Glasgow Coma Scale or GCS of E4V5M6) with temperature of 38.1 degree Celsius. His blood pressure was 107/53mmHg and pulse rate was 78 bpm. Physical examination showed tenderness without a rebounding pain over his right upper abdomen. His laboratory studies revealed leukocytosis with neutrophils predominant (WBC:11.79 103/uL, Neutrophil: 86.3%) and impaired liver function (AST:476 IU/L; ALT: 332 IU/L) with hyperbilirubinemia mainly of direct type (D-bilirubin:1.7 mg/dL; T-Bilirubin: 3.0 mg/dL). Neither elevation of cardiac enzymes (CPK:81IU/L, CKMB:1.73ng/mL, Troponin I<0.16ng/mL) nor ST changes in electrocardiogram was found. Under a provisional diagnosis of acute cholangitis, he was started on cefoxitin eight hours earlier before admission to ward which was uneventful. Intravenous ranitidine was given at ward for prophylaxis of stress ulcer, although the risk for gastrointestinal bleeding in this patient was not high. Just within minutes after the injection of one ample of ranitidine (Zantac (Getway), 50mg/2ml/amp) in slow push mode (within 10 seconds), patient complained about itchiness all over his body with facial redness. He started to have shortness of breath and cold sweating. Shortly after his conscious levels deteriorated (GCS: E1V2M1) followed by cardio-respiratory collapse. In addition to endotracheal intubation and cardiopulmonary cerebral resuscitation (CPCR) for his cardiorespiratory collapse, adequate doses of hydrocortisone and anti-histamine were given. However, patient did not survive the CPCR and expired 30 mins later. His blood culture yielded E. Coli which was compatible with the initial diagnosis of acute cholangitis. Based on his previous medical record, he did not have any atopic predisposition or drug allergy history. He was ever given with intravenous proton pump inhibitor during cholecystectomy one and a half year ago without a record of allergy.