Anaphylactoid reaction to Vancomycin: a literature review on Red Man Syndrome (RHS)

Abstract

Red Man Syndrome (RMS), or Vancomycin Flushing Syndrome, is characterized by allergic manifestations to the use of Vancomycin, an antibiotic of the beta-lactam class used in the treatment of bacterial infections. This study aimed to analyze the pharmacological mechanisms of Vancomycin in association with the RMS clinical aspects, in addition to a review of the pathophysiology, epidemiology, clinical manifestations, diagnosis and treatment, as well as new perspectives and scientific advances that can improve the management of the anaphylactoid reaction. A search was performed in the SciELO, PubMed and Google Scholar databases using the keywords “Vancomycine”, “Adverse Reactions” and “Red Man Syndrome”, with a time range from 2003 to 2024. The syndrome is characterized by an anaphylactoid reaction after infusion rapid dose of Vancomycin, manifesting itself in a similar way to anaphylaxis, but without the mediation of Immunoglobulin E (IgE), with histamine being the main substance responsible for the manifestations. Some research indicates that the incidence of the condition is around 5–13%, especially when the infusion is administered in less than 1 hour. However, other literature disagrees, pointing out that the incidence of the syndrome can reach 47%. The most common clinical manifestation is the association between generalized itching and erythematous skin eruptions, mainly affecting the face, neck and body. The diagnosis of the syndrome is clinical, based on the observation of signs and symptoms that appear during or shortly after intravenous administration. Treatment consists of antihistamine pre-treatment for mild and moderate cases and reducing the infusion rate by 50%, or at least 1 gram in 2 hours, while for more severe cases rapid desensitization must be performed, which consists of administering small doses of vancomycin until reaching the therapeutic dose, in addition to ceasing the use of opioids. Finally, it is concluded that RMS corresponds to an extremely complex condition, requiring caution regarding the infusion of the drug and that it deserves a close look at its main particularities.