Hypersensitivity reactions to tramadol are rare and the drug is commonly considered safe. Here, we report the first case of anaphylaxis to tramadol in a child. We point out the difficulty in reaching a confident diagnosis when testing opioid alkaloid drugs with histamine-releasing properties. Additionally, we showed the importance of a well-performed allergy work-up, especially when testing drugs with low experience and when standardized concentrations have not been tested. Moreover, this case provides insight into the possibility of severe reactions, and even anaphylaxis, to tramadol.

www.karger.com/pha J. Asai, Kyoto, Japan Gen-ichi Atsumi, Teikyo, Japan Jie Bai, Kunming, China B. Bermas, Boston, Mass., USA Pangala V. Bhat, Montreal, Que., Canada De-Liang Cao, Springfield, Ill., USA D. Cheng, Princeton, N.J., USA Young Sik Cho, Daegu, Korea Hartmut Derendorf, Gainesville, Fla., USA Salvatore Di Somma, Rome, Italy Dong Hailong, Xi’an, China Erol Kevser, Eskisehir, Turkey S. Espuelas, Pamplona, Spain Jun Fang, Kumamoto, Japan Patrice Forget, Brussels, Belgium Masanori Fujii, Kyoto, Japan T. Fujii, Kyotanabe, Japan Li Gan, Madison, Wisc., USA Luis Granero, Valencia, Spain Ki Baik Hahm, Seongnam, Korea Abid Hamid, Jammu, India Philippe Haouzi, Hershey, Pa., USA R. Hardeland, Göttingen, Germany Chaoyong He, Oklahoma City, Okla., USA Christopher Henstridge, Budapest, Hungary Stan Heptinstall, Nottingham, UK Thomas Hohlfeld, Düsseldorf, Germany Masatoshi Hori, Tokyo, Japan T.M. Hu, Taipei, Taiwan Longshuang Huang, Chicago, Ill., USA Christian Humpel, Innsbruck, Austria Iacobazzi Dominga, Bristol, UK K. Iga, Kyotanabe, Japan S. Iino, Fukui, Japan N. Inagaki, Gifu, Japan N. Inatomi, Fijisawa, Japan Keiichi Ishihara, Kyoto, Japan Y. Isohama, Chiba, Japan Yukako Ito, Kyoto, Japan B. Jugdutt, Edmonton, Alta., Canada H. Katsuki, Kumamoto, Japan Atsufumi Kawabata, Higashiosaka, Japan Naoyuki Kawao, Osaka, Japan So Hee Kim, Suwon, Korea Yoshihisa Kitamura, Kyoto, Japan Heidemarie Kletzl, Basel, Switzerland Ipek Komsuoglu Celikyurt, Kocaeli, Turkey Veerapol Kukongviriyapan, Khon Kaen, Thailand S.W.S. Leung, Hong Kong, Hong Kong Karen Liby, Hanover, N.H., USA Zhen-Guo Liu, Columbus, Ohio, USA Kexin Liu, Dalian, China Xiaowen Liu, Houston, N.Y., USA Z. Lu, New York, N.Y., USA Christopher J. Lynch, Hershey, Pa., USA Hisashi Matsuda, Kyoto, Japan K. Matsumoto, Kyoto, Japan S. Matsumoto-Okano, Fujisawa, Japan Shogo Matsuyama, Himeji, Japan K. Miyata, Tsukuba, Japan D. Miyazawa, Nagoya, Japan Nobuaki Mizutani, Kobe, Japan E. Morii, Suita, Japan H. Motohashi, Kyoto, Japan V. Murthy, Rochester, N.Y., USA Rais Mustafa, Kuala Lumpur, Malaysia Takeshi Nabe, Kyoto, Japan T. Nabe, Hirakata, Japan Y. Naito, Kyoto, Japan Tsutomu Nakahara, Tokyo, Japan Tetsuo Nakata, Kyoto, Japan Yuji Nakayama, Kyoto, Japan H.J. Nam, Scottsdale, Ariz., USA Pierluigi P. Navarra, Rome, Italy Hiroyuki Nishikawa, Osaka, Japan Tomoyuki Nishizaki, Nishinomiya, Japan R. Noland, Baton Rouge, La., USA S. Ohya, Kyoto, Japan A. Overby, Trondheim, Norway Y. Oyama, Tokushima, Japan Vera Petricevich, Cuernavaca, Mexico Nikolaos Pitsikas, Larissa, Greece Y. Qi, Temple, Pa., USA D.L. Quinn, Tucson, Ariz., USA S. Reisman, Irving, Tex., USA M. Ruggero, New Haven, Conn., USA Samir Saha, Stockholm, Sweden Y. Sawada, Fukuoka, Japan

Although reversible H2 receptor antagonists are usually well tolerated, there are few reports on anaphylactic reactions triggered by ranitidine. Here we report the first case of anaphylaxis to ranitidine in a child. This was an IgE-mediated event occurring in a patient who had never used ranitidine before.