From the Guidelines
Redman syndrome is a hypersensitivity reaction that occurs during or shortly after the intravenous administration of vancomycin, a glycopeptide antibiotic, and can be prevented by administering vancomycin slowly, typically over at least 60 minutes, with a recommended infusion rate not exceeding 10 mg/minute, as recommended by the most recent guidelines 1.
Characteristics of Redman Syndrome
- Characterized by flushing and reddening of the face, neck, upper body, and arms
- Often accompanied by itching, rash, and sometimes low blood pressure
- Caused by histamine release from mast cells due to rapid infusion of vancomycin
Prevention and Management
- Administer vancomycin slowly, typically over at least 60 minutes, with a recommended infusion rate not exceeding 10 mg/minute
- Premedication with antihistamines like diphenhydramine may help prevent recurrence in patients with a history of the reaction
- If a patient experiences this reaction, the infusion should be temporarily stopped and can usually be restarted at a slower rate after symptoms resolve
Importance of Proper Administration
- Redman syndrome is generally not life-threatening, but its alarming appearance should not be confused with a true allergic reaction to vancomycin, which would contraindicate further use of the drug
- Proper administration and monitoring can help prevent Redman syndrome and ensure safe and effective use of vancomycin, as supported by recent studies 1.
From the FDA Drug Label
Severe Dermatologic Reactions such as... Red Man Syndrome have been reported in association with the use of vancomycin
Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing (see Pediatric Use, PRECAUTIONS) and anaphylactoid reactions (see ADVERSE REACTIONS)
There have been reports that the frequency of infusion-related events (including hypotension, flushing, erythema, urticaria, and pruritus) increases with the concomitant administration of anesthetic agents.
Red Man Syndrome is a severe dermatologic reaction associated with the use of vancomycin, characterized by symptoms such as:
- Erythema
- Flushing
- Hypotension
- Urticaria
- Pruritus It is often caused by rapid infusion of vancomycin and can be minimized by administering the drug slowly as a dilute solution 2, 2.
From the Research
Definition of Redman Syndrome
- Redman syndrome, also known as vancomycin flushing syndrome (VFS), is a pseudoallergic reaction characterized by flushing, erythema, and pruritus 3.
- It is a well-known adverse reaction that occurs in patients receiving vancomycin, particularly when administered rapidly 4, 5.
Symptoms of Redman Syndrome
- Symptoms of redman syndrome include rash, itching, hypotension, and flushing 4, 3, 5.
- The severity of symptoms can range from mild to severe, and in some cases, may lead to anaphylaxis 3.
Risk Factors for Redman Syndrome
- Risk factors for redman syndrome include age > 2 years, previous history of redman syndrome, vancomycin dose, and vancomycin concentration 5.
- Antecedent antihistamine use has also been identified as a risk factor for redman syndrome 5.
- Caucasian ethnicity and vancomycin dose ≥ 10 mg/kg are also associated with an increased risk of redman syndrome 5.
Prevention and Treatment of Redman Syndrome
- Pretreatment with antihistamines, such as hydroxyzine, can provide significant protection against vancomycin-induced redman syndrome 4, 6.
- Oral antihistamines have been shown to be as effective as intravenous antihistamines in reducing the incidence and severity of redman syndrome 4.
- Discontinuing vancomycin, administering corticosteroids and antihistamines, and monitoring for anaphylaxis are also important steps in managing redman syndrome 3.