Vancomycin anaphylactoid reactions with

Antihistamines (Hi receptor antagonists) prevent anaphylactoid reactions to vancomycin (16). The recommended method of administration is by intravenous infusion of a solution of 0.25-0.5% over 60 minutes, and patients have to be monitored closely. A possible red man syndrome has also been associated with systemic absorption of oral vancomycin in a patient with normal renal function (17). 

The authors of the second report could not exclude that the previous anaphylactoid reaction had not been due to gentamicin, as no specific testing was done. Although successful vancomycin desensitization has been described, this would be the first time in a patient with a history of anaphylactoid reaction. 

Some authors stress the fact that vancomycin can interact with anesthetic drugs, particularly muscle relaxants. In the reported cases anaphylactoid reactions were seen, with intense erythema and marked permeability changes (125). 

In the early years of its use, vancomycin developed a reputation as being a relatively toxic drug. The most important side effects associated with vancomycin therapy are an anaphylactoid reaction referred to as the red man syndrome or the red neck syndrome, ototoxicity, and nephrotoxicity. Typically, the red man syndrome develops upon rapid infusion of vancomycin and consists of pruritus, a rash involving the face. 

Vancomycin is highly associated with adverse infusion-related events. These are especially prevalent with higher doses and a rapid infusion rate. A rapid infusion rate has been shown to cause anaphylactoid reactions, including hypotension, wheezing, dyspnea, urticaria, and pruritus. A significant drug rash (the so-called red man syndrome) also can occur. These events are much less frequent with a slower infusion rate. 

Despite a number of reports that cover a range of systemic and dermatologic reactions, severe reactions including true type I responses are rare. An anaphylactoid reaction to infused vancomycin reported in a patient with vancomycin-induced red man syndrome was interpreted, somewhat obscurely, as a possible case of true vancomycin allergy. Other cases induced by vancomycin, but also showing cross-sensitization... 

A 47-year-old white woman with end-stage renal disease had had anaphylactoid shock after vancomycin 1 g intravenously infused over 1.5 hours and gentamicin 90 mg 3 years before, despite premedication with diphenhydramine (89). She was treated with doubling doses of vancomycin every 30 minutes for methicillin-resistant S. epidermidis. She had no reaction. 

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