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, Volume 36, Supplement 2, pp C238–C241 | Cite as

Therapeutic efficacy of combined -receptor-antagonists on severe histamine-induced cardiovascular reactions in humans

  • M. Tryba
  • M. Zenz
  • H. Thole
Plenary Lecture Symposium on Histamine and Antihistamine in Anaesthesia and Surgery (iii) Prophylaxis and Treatment of Histamine-Involved Anaphylactoid Reactions in Anaesthesia and Surgery


Histamine is a well known causal factor in a variety of clinical events and complications, especially in allergic and anaphylactoid reactions. We therefore investigated whether a dose-dependent therapeutic effect of H1+H2-antagonists (dimethindene maleate+cimetidine) could be shown in the treatment of a histamine-induced cardiovascular reactions in humans. 6 healthy male volunteers participated in a randomized single-blind crossover-study. A histamine dosage leading to a decrease of the mean arterial pressure to 60 mmHg within 2 min was continuously infused over a period of 15 min on two occasions. The volunteers received either histamine+saline or histamine+treatment first. Treatment started 3 min after the start of the histamine infusion (4 mg dimethindene maleate+200 mg cimetidine i.v.) and was repeated every 2 min until the cardiovascular baseline values were reached or 15 min were completed. Statistical analysis of the treatment effect was performed on an intraindividual basis (ANOVA) withp<0.05 In both treatment courses mean MAP decreased to about 60 mmHg. While in the saline group MAP remained at this low level during the time of histamine infusion, all volunteers quickly responded to treatment with dimethindene maleate+cimetidine. After 8 mg dimethindene maleate+400 mg cimetidine MAP reached baseline values in all volunteers (p<0.01). Mean HR increased to 119 bpm in the saline group after 3 min. Treatment with dimethindene maleate+cimetidine showed similar efficacy against histamine-induced tachycardia (p<0.01). It may thus be concluded that usual dosages of H1- and H2-receptor-antagonists are effective in the treatment of histamine-induced cardiovascular reactions.


Histamine Therapeutic Effect Arterial Pressure Clinical Event Cimetidine 
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  1. [1]
    B. S. Bochner and L. M. Lichtenstein,Anaphylaxis, N. Engl. J. Med.324, 1785–1790 (1991).PubMedGoogle Scholar
  2. [2]
    H. De Soto and P. Turk,Cimetidine in anaphylactic shock refractory to standard therapy. Anesth. Analg.69, 264–265 (1989).Google Scholar
  3. [3]
    M. M. C. D. Fisher,Clinical observations on the pathophysiology and treatment of anaphylactic cardiovascular collapse. Anaesth. Intens. Care14, 17–21 (1986).Google Scholar
  4. [4]
    J. W. Flacke, A. Van Etten and W. E. Flacke,Greatest histamine release from meperidine among four narcotics. Double-blind Study in Man. Anesthesiology Volume59, A 51 (1983).PubMedGoogle Scholar
  5. [5]
    G. A. Gerlock,Cimetidine: a useful drug for the treatment of anaphylaxis. J. Am. Assoc. Nurse. Anesth. 608–610 (1983).Google Scholar
  6. [6]
    R. P. Harvey, J. Wegs and A. L. Schocket,A controlled trial of therapy in chronic urticaria. J. Allergy. Clin. Immunol.68, 262–266 (1981).PubMedGoogle Scholar
  7. [7]
    J. R. Kambam, W. H. Merill and B. E. Smith,Histamine-2-receptor blocker in the treatment of protamine related anaphylactoid reactions: two case reports. Can. J. Anaesth.36, 463–465 (1989).PubMedGoogle Scholar
  8. [8]
    W. Lorenz, W. Dietz, M. Ennis, B. Stinner and A. Doenicke,Histamine in anaesthesia and surgery: causality analysis. In.Handbook of Experimental Pharmacology, Vol. 97. Histamine and Histamine Antagonists (Ed. B. Uvnäs) pp. 385–439. Springer-Verlag Berlin Heidelberg 1991.Google Scholar
  9. [9]
    W. Lorenz, M. Ennis, A. Doenicke and W. Dick,Perioperative uses of histamine antagonists. J. Clin. Anesth.2, 345–360 (1990).CrossRefPubMedGoogle Scholar
  10. [10]
    H. Mayumi, S. Kimura, M. Asano, T. Shimokawa, T. F. AuYong and T. Yayama,Intravenous cimetidine as an effective treatment for systemic anaphylaxis and acute skin reactions. Ann. Allergy58, 447–450 (1987).PubMedGoogle Scholar
  11. [11]
    J. Moss, D. M. Philbin, C. E. Rosow, S. J. Basta, C. Gelb and J. J. Savarese,Histamine release by neuromuscular blocking agents in man. Klin. Wschr.60, 891–895 (1982).CrossRefPubMedGoogle Scholar
  12. [12]
    J. Moss, M. F. Roizen, E. J. Nordby, R. Thisted, J. L. Apfelbaum and D. J. McDermott,Decreased incidence and mortality in chymopapain anaphylaxis. Anesthesia and Analgesia64, 1197–1201 (1985).PubMedGoogle Scholar
  13. [13]
    J. Moss and C. E. Rosow,Histamine release by narcotic and muscle relaxants in man. Anesthesiology59, 330–339 (1983).PubMedGoogle Scholar
  14. [14]
    D. M. Philbin, J. Moss, C. W. Akins, C. E. Rosow, K. Katsuakira, R. C. Schneider, T. R. Verlee and J. J. Savarese,The use of H 1 and H 2 histamine blockers with high dose morphine anesthesia: A double blind study. Anesthesiology55, 292–296 (1981).PubMedGoogle Scholar
  15. [15]
    H. D. Röher, W. Lorenz, H. Lennartz, J. Kusche, W. Dietz, G. Gerdes and J. V. Parkin,Plasma histamine levels in patients in the course of several standard operations: influence of anaesthesia, surgical trauma and blood transfusion. Klin. Wschr.60, 926–934 (1982).CrossRefPubMedGoogle Scholar
  16. [16]
    M. Tryba, I. Linde, G. Voshage and M. Zenz,Histaminfreisetzung und cardiovaskuläre Reaktionen nach Implantation von Knochenzement bei totalem Hüftgelenksersatz. Anaesthesist40, 25–31 (1991).PubMedGoogle Scholar
  17. [17]
    M. Tryba, F. Zevounou and M. Zenz,Prophylaxe anaphylaktoider Reaktionen mit Promethazin unc Cimetidin bei intramuskulärer Applikation. Untersuchungen am Histamininfusions-Modell. Anaesthesist33, 218–223 (1984).PubMedGoogle Scholar

Copyright information

© Birkhäuser Verlag 1992

Authors and Affiliations

  • M. Tryba
    • 1
  • M. Zenz
    • 1
  • H. Thole
    • 1
  1. 1.Dept. Anesthesiology, Intensive Care Medicine and Pain TherapieUniversity Hospital BergmannsheilBochumGermany

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