Vancomycin histamine release

Antibiotics. Antibiotics are commonly administered peroperatively. At the present time, allergy to (3-lactams represents 12-15% of the peroperative reactions observed in France [9]. Vancomycin, which is increasingly used for prophylaxis, has been incriminated in some cases. The red man syndrome is due to non-specific histamine release induced by a rapid intravenous administration [21]. 

Vancomycin dosages should be infused during course of at least 1 hour to reduce risk of histamine-release "red man" syndrome. 

The answer is a. (Hardman, p 1146J The red man 1 syndrome is associated with vancomycin, thought to be caused by histamine release. Prevention consists of a slower infusion rate and pretreatment with antihistamines... 

Vancomycin can cause red-man syndrome consisting of diffuse flushing, presumably mediated by histamine-release. This problem can be prevented by limiting the infusion rate. The most serious adverse reactions are ototoxicity and nephrotoxicity. The toxicity for both organ systems is potentiated by aminoglycosides. Vancomycin will cross the placenta barrier and has the potential to cause fetal ototoxicity. 

Healy DP et al. Vancomycin-induced histamine release and red man syndrome Comparison of 1- and 2-hour infusion. Antimicrob Agents Chemother 1990 34 550-554. 

Erythema multiforme Stevens-Johnson syndrome sulphonamides Red-man syndrome (vasodilatation-hypotension due to histamine release) characteristic of rapid administration of vancomycin... 

DEPOLARIZING, NON-DEPOLARIZING VANCOMYCIN 1. t efficacy of these muscle relaxants 2. Possible risk of hypersensitivity reactions 1. Vancomycin has some neuromuscular blocking activity 2. Animal studies suggest additive effect on histamine release 1. Monitor neuromuscular blockade carefully 2. Be aware... 

Adverse effects. The main disadvantage to vancomycin is auditory damage. Tinnitus and deafness may improve if the drug is stopped. Nephrotoxicity and allergic reactions also occur. Rapid i.v. infusion may cause a maculopapular rash possibly due to histamine release (the red person syndrome). 

The red man syndrome associated with rapid infusion of vancomycin, resulting in histamine release, is very rarely seen with teicoplanin. Teicoplanin can usually be safely administered to patients with a history of red man syndrome due to vancomycin, as has been confirmed in six children treated with teicoplanin for febrile neutropenia and Gram-positive bacteremia (14). 

A unique and peculiar adverse reaction related to the rapid infusion of large doses is the so-caUed red neck or red man sjmdrome. It is the most common adverse reaction to vancomycin, characterized by fever, chills, paresthesia, and eiythema at the base of the neck and the upper back, and can be followed by a hypotensive episode (12). It is not a true allergic reaction. It seems to be due to vancomycin-induced release of histamine and possibly other vasoactive substances without the involvement of preformed antibodies (13,14). In rat peritoneal mast cells vancomycin provoked histamine release dose-dependently fosfomycin inhibited this effect (15). 

Possible sjmergism between vancomycin and narcotics in the induction of red man sjmdrome due to histamine release has been suggested in a 19-year-old women treated with fentanyl and vancomycin during orthopedic surgery (23). Evidence from an animal study has suggested that the risk can also be enhanced by the co-administration of muscle relaxants, resulting in enhanced release of histamine (24). 

Toyoguchi T, Ebihara M, Ojima F, Hosoya J, Shoji T, Nakagawa Y. Histamine release induced by antimicrobial agents and effects of antimicrobial agents on vancomycin-induced histamine release from rat peritoneal mast cells. J Pharm Pharmacol 2000 52(3) 327-31. 

Shuto H, Sueyasu M, Otsuki S, Kara T, Tsuruta Y, Kataoka Y, Oishi R. Potentiation of vancomycin-induced histamine release by muscle relaxants and morphine in rats. Antimicrob Agents Chemother 1999 43(12) 2881. ... 

Editorial. Red men should go vancomycin and histamine release. Lancet 1990 335 1006-1007. 

Many compounds, including a large number of therapeutic agents, stimulate the release of histamine from mast cells directly and without prior sensitization. Responses of this sort are most likely to occur following intravenous injections of certain substances. Tubocurarine, succinyl-choline, morphine, some antibiotics, radiocontrast media, and certain carbohydrate plasma expanders may elicit the response. The phenomenon may account for unexpected anaphylactoid reactions. Vancomycin-induced red-man syndrome involving upper body and facial flushing and hypotension may be mediated through histamine release. 

UNTOWARD EFFECTS Among the hypersensitivity reactions produced by vancomycin are rashes and anaphylaxis. Chills and fever may occur. Rapid intravenous infusion may cause erythematous or urticarial reactions, flushing, tachycardia, and hypotension. The extreme flushing that can occur is called red-neck or red-man syndrome. This results from a direct toxic effect of vancomycin on mast cells to induce histamine release. 

A man recovering from neuromuseular bloekade with suxamethonium (with some evidence of residual Phase II bloek) developed almost total muscle paralysis and apnoea when given an intravenous infusion of vancomycin. He recovered spontaneously when the vancomycin was stopped, but it took several hours. The neuromuseular blockade due to vecuronium was increased in a patient when given an infusion of vancomycin (I g in 250 mL of saline over 35 minutes). Transient apnoea and apparent cardiac arrest have also been described in a patient following a I-g intravenous injection of vancomycin given over 2 minutes. However, in both of these cases the vancomycin was given more rapidly than the current recommendations. It is now known that rapid infusion of vancomycin can provoke histamine release, which can result in apnoea, hypotension, anaphylaxis and muscular spasm, effects similar to those seen in these two patients. 

The chemically similar teicoplanin, not approved in the USA, is not inferior to vancomycin with regard to efficiency of treating grampositive infections. It shows a lower rate of adverse reactions, particularly nephrotoxicity and, as already discussed, is used as a substitute for vancomycin in red man syndrome. When hypersensitivity reactions do occur with teicoplanin they are generally of the delayed type, but there are a few documented cases of apparent IgE antibody-mediated reactions implicated, for example, by an immediate wheal and flare skin reaction to the drug or by teicoplanin-induced histamine release from a patient s basophils. Despite the chemical and pharmacological... 

Sahai J, Healy DP, Shelton MJ, et al. Comparison of vancomycin- and teicoplanin-induced histamine release and red man syndrome . Antimicrob Agents Chemother. 1990 34 765-9. 

Respiratory Occupational asthma occurred in a pharmaceutical employee who worked for 10 months as a production worker with vancomycin powder [89" ]. After 5 months he complained of rhinitis, cough, dyspnea, and chest discomfort. Vancomycin-associated occupational asthma was diagnosed. An intradermal test was positive and there was a significant increase in histamine release capacity, but specific IgE or IgG antibodies were not identified. Direct histamine release by vancomycin was suggested as the possible mechanism. 

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