Vancomycin is infused rapidly over 15 minutes instead of the recommended duration. Within minutes the patient develops flushing of the face, neck, and upper torso with hypotension. The mediator and the preventive measure are:

• A IgE-mediated histamine release; skin testing before future doses
• B Complement activation via the classical pathway; plasmapheresis before subsequent doses
• C Bradykinin accumulation due to kininase inhibition; discontinuation of all glycopeptides permanently
• D Direct mast-cell degranulation independent of IgE; slower infusion rate and antihistamine premedication ✓

Explanation

Red man syndrome, also called red neck syndrome, is a rate-related infusion reaction caused by direct, non-IgE-mediated release of histamine from mast cells and basophils triggered by rapid vancomycin administration. It is prevented by infusing the dose over at least 60 minutes and can be attenuated with antihistamine premedication. It is not a true allergy, so desensitization or permanent avoidance is unnecessary.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.