Red man syndrome is an idiosyncratic reaction to vancomycin (a glycopeptide antibiotic that treats serious infections) that combines pruritic, itchy rash of the face and neck with possible anaphylactoid symptoms. The reaction can occur if the drug is infused too rapidly.
Antihistamine prophylaxis, low doses of the antibiotic given over four hours, and slow infusion rate can all significantly reduce the incidence and severity of the reaction.
Causes
Vancomycin is a powerful antibiotic that is effective in treating serious bacterial infections like MRSA, but it can cause red rash or itchiness on the body, face, neck, and arms. It is caused by an allergic reaction to the antibiotic that triggers a release of histamine. The rash usually appears within four to ten minutes of the start of the vancomycin infusion. It can also occur as a result of oral or intravenous administration of the medication. It is an anaphylactoid reaction and must be distinguished from hives, which are usually triggered by IgE antibodies and can cause a life-threatening reaction such as anaphylactic shock.
The rash is caused by the degranulation of mast cells and basophils, which results in the release of histamine independent of preformed IgE or complement. The histamine causes vasodilation, which leads to vascular inflammation and redness of the skin. It also causes itching of the skin, as well as other symptoms such as hypotension and tachycardia.
It can also lead to respiratory distress or even cardiac arrest in severe cases. Symptoms may be more severe in children than adults and can range from mild to severe, but they are generally not life-threatening. The rash appears in the upper part of the body, with itching typically occurring on the face, neck, and arms. In some cases, the rash can be so itchy that patients scratch themselves to the point of breaking the skin.
In the past, RMS was only seen when the drug was given intravenously, but it is increasingly being used as an infection prophylaxis for surgical disciplines such as neurosurgery. This has led to an increase in the number of cases of RMS occurring from local injection of the medication into the surgical wound, a technique being used more frequently.
The rash and symptoms can be very unpleasant for the patient, but it is not considered to be dangerous, especially if the dosage is stopped right away. The symptoms should clear up in around 20 minutes, and antihistamines can be taken to alleviate the symptoms. If the rash persists, a visit to FastMed Urgent Care may be necessary for diagnosis and treatment.
Symptoms
Vancomycin is an antibiotic that’s great at battling infections like staph and Clostridium difficile, but it can cause an uncomfortable side effect known as red man syndrome. The condition is characterized by a red, itchy rash on the face and upper body. While it can be serious if the patient develops chest pains or low blood pressure, the reaction is typically easy to treat at FastMed Urgent Care clinics located throughout the country.
Previously, the drug’s unpleasant reactions were blamed on impurities in the medication, earning it the nickname “Mississippi mud.” However, since then, it has been found that an unknown percentage of patients have mast cells that are prone to degranulation upon exposure to the medication, which results in the release of histamine. The histamine triggers a hypersensitivity reaction that resembles anaphylactic shock, though it is less severe.
Red man syndrome occurs more frequently when the medication is infused too quickly. Infusion rates of one gram per hour have been associated with the reaction, so most hospitals now require that the drug be given at a slower rate of 10 milligrams per minute. In addition, patients are sometimes pretreated with antihistamines to decrease the risk of an adverse reaction.
The rash that results from red man syndrome can appear anywhere on the body, but it is typically concentrated on the face, neck and shoulders. The rash can also cause a sensation of itching all over the body, called pruritus. In severe cases, itching can be accompanied by tachycardia, hypotension, watery eyes and difficulty breathing.
In some cases, the symptoms of red man syndrome can lead to a life-threatening situation in which bacteria from an infection enter the bloodstream and cause organ failure. This is called sepsis, and it can be deadly if not treated promptly.
A recent study found that patients who have red man syndrome are more likely to be male and white, and are more likely to have documentation of an allergy to the medication. This can have real-world implications, as patients who are documented to be allergic to the drug will often get a different antibiotic instead empirically.
Diagnosis
Vancomycin is used to treat serious bacterial infections including those caused by methicillin-resistant Staphylococcus aureus (MRSA). It works by blocking the bacteria’s ability to make cell walls. The antibiotic is given intravenously as an IV infusion. It is often administered in intensive care units. It is also sometimes used to prevent allergic reactions to penicillin or cephalosporins. Red man syndrome is a reaction to vancomycin that produces redness and itching of the skin and sometimes other parts of the body.
The primary signs and symptoms of this condition are an erythematous rash on the face, neck, torso, or upper-middle part of the body. The rash is itchy, and the lips may become dry or chapped. In severe cases, the skin can thicken and begin to chip. The nails can develop ridges and become brittle. Nausea and vomiting may also occur. In some cases, the rash can affect the eyes and nose. Patients that experience this reaction should be evaluated for anaphylaxis, which is a more severe allergic response and can be life-threatening.
Diagnosing this condition is usually easy. Your doctor will look at your skin and ask about your symptoms. They will also take a sample of your blood for testing. If you are taking other medications, they will want to know which ones you take and how often. This is because some drugs can interact with vancomycin and increase your chances of developing this reaction.
If you have a history of allergies, your doctor might give you antihistamines before administering this medication. They will also instruct you to take this drug in small and frequent doses for better tolerance. In a study, it was found that pretreatment with the histamine-1 antagonist (hydroxyzine) offered significant protection against the development of vancomycin-induced erythema and pruritus. Ranitidine did not offer the same level of protection.
This condition is also called vancomycin flushing syndrome (VFS). It is an anaphylactoid reaction because the drug triggers mast cells and basophils to release histamine independent of preformed IgE antibodies. It is different from anaphylactic shock, which is mediated by IgE antibodies and shows symptoms like hives and stridor.
Treatment
The antibiotic vancomycin is a potent and effective treatment for a variety of infections, including MRSA and some bloodstream infections. However, it can also trigger a reaction called red man syndrome in some patients. The disorder is characterized by an itchy red rash that covers the face, neck, and upper torso. It is usually mild and not dangerous, though severe cases can cause hypotension and tachycardia (fast heart rate).
The exact cause of the reaction is unknown, but it appears to be caused by degranulation of mast cells and basophils in response to the drug. Histamine is released by these cells, and it causes the rash and other symptoms. The disorder is a type of anaphylactoid reaction, but it differs from anaphylactic shock in that it is not mediated by immunoglobulin antibodies.
When the reaction occurs, it is most commonly seen during intravenous administration of the antibiotic, but it can also occur when it is taken by mouth or injected into a vein. The rash typically begins within 15 minutes of starting the infusion, but it can appear as early as one minute. The condition is more likely to happen when the infusion rate is high, but it can also affect patients who have never had a similar reaction before.
Other medications can also trigger red man syndrome, including rifampicin, ciprofloxacin, levofloxacin, amphotericin B, and Teicoplanin. This is because these drugs can also cause mast cell degranulation, which produces histamine. Additionally, certain pain medications or contrast dyes can cause the reaction in some patients, because they release histamine as well.
A recent study found that the term “red man syndrome” is often misinterpreted as an allergy to the antibiotic, and that it can lead to suboptimal care. The authors of the study suggested that pharmacists should use alternative terms like “vancomycin infusion reaction” to avoid this misunderstanding.