Mechanism: non-immune, probably histamine release, possibly serotonin or bradykinin
Drugs associated with occurrence of the red man syndrome:
(1) vancomycin
(2) teichoplanin
Clinical features:
(1) skin itch
(2) erythematous maculopapular skin rash, especially over the upper body
(3) feeling of warmth over head and upper body
(4) hypotension
(5) angioedema
(6) tachycardia
(7) muscle aches (variable)
Bronchospasm is not a feature of the reaction.
The reaction may start during the infusion and resolves shortly after the infusion is stopped.
Risk factors:
(1) rapid intravenous infusion of the antibiotic
(2) history of previous episode
(3) first dose in a regimen
Prevention:
(1) pretreatment with antihistamines with or without acetaminophen
(2) infusion over 60 minutes or more
