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Red Man Syndrome: Causes, Symptoms and Treatment

by Dr. Joe Morales

Found red rashes on your face and neck? Wait! It may be a symptom of Red Man Syndrome. It is a reaction to the application of Vancomycin. It is a drug used to treat different kinds of bacterial infections. Have you ever experienced how bacterial infection works? We all have some sort of experience with such infections at some point in life. Bacterial infections are not rare. As per the study, nearly 5% to 11% of hospitalized people suffer from nosocomial disorder. It is a kind of infection that originated in healthcare units and hospitals due to several reasons.  

And for many patients, it often leads to severe complications. So, under such circumstances, a powerful remedy is highly needed to cure such infections. Vancomycin is the drug for this. It dominates the strains of staphylococci, Corynebacterium jeikeium, and Streptococcus pneumonia. So, medical experts also use it for serious health issues like endocarditis, etc. 

This effective remedy called Vancomycin can cause two different types of hypersensitivity reactions. One is anaphylaxis, and another one is Red Man Syndrome. As per the study, nearly 47% of patients suffer from this syndrome after the infusion of Vancomycin. Usually, patients younger than the age of 40 tend to suffer from it. So, what is this red syndrome? How to diagnose it? Is there any cure for it? Let’s know the answers in detail.  

Red Man Syndrome: What is it? 

As we discussed earlier, Red Man Syndrome is a common reaction to the anti-bacterial drug called Vancomycin. Also known as Red Neck Syndrome, it brings in red rashes on the face, neck, and upper body parts. Usually, the rashes are likely to be seen during or after the infusion of the drug called vancomycin.  

Although, you can generally see it within 10 to 20 minutes after the injection, sometimes patients may experience delayed reactions. The additional symptoms that may occur along with Red Man Syndrome are breathing trouble, dizziness, headache, fever, chest pain, hypotension, etc. If the syndrome occurs in the scalp, it may result in hair loss. Sometimes, people experience many other different symptoms. The symptoms include nausea, vomiting, fainting, fatigue, swollen lymph nodes, low blood pressure, unusual heart rates, dehydration, etc.  

Red Man Syndrome: Why it Happens? 

Previously, it was believed that the syndrome resulted from some impurities found in the vancomycin drug. But the recent research tells a different story. When it was seen that even after infusing purified drugs, such troubles are occurring, the specialists delved into the more extensive study. And modern research says that it is the result of the overstimulated immune response to the drug. The immune cells named mast cells are likely to cause allergic reactions. The cells produce a high amount of histamine, an amine compound causing inflammation.  

As per the experts, this heavy release of histamine results in the occurrence of Red Man Syndrome. It is seen that up to 500 mg of the drug causes no harm, while 1 g of it may increase the histamine level. So, it is important to have a check on the dosage.  

Vancomycin is not the only culprit here. Some other causes may lead to the Red Man Syndrome. We can mention some antibiotics here. The antibiotics that may cause such syndrome are-  

  • Ciprofloxacin 
  • Amphotericin 
  • Brifampcin 
  • teicoplanin 

These drugs can also invite red rashes. How do they do that? Let us tell you. It is very similar to vancomycin. It directly degranulates the mast cells and basophils. And gradually, it leads to the occurrence of the syndrome. The symptoms may increase if these antibiotics and vancomycin is put together. Also, if a patient is taking vancomycin and opioid analgesics together, it may cause excessive histamine release. Muscle relaxants or contrast dye can also do the same.  

Usually, patients with some existing medical conditions are more likely to be affected by this syndrome. The health conditions include lung cancer, HIV, and Graft-versus-host disease. For your information, graft-versus-host disease is a reaction after a bone marrow transplant.  

The Risk Factors of the Syndrome 

One of the significant risk factors of the red man syndrome is a quick infusion of vancomycin. So, it is advised to infuse it slowly. At least, take one hour for it. As we discussed the people under the age of 40 are more likely to be affected by this. So, it is better to avoid giving the drug. Also, the syndrome may come recurrently. If you have experienced it before, you may have it in the future. Well, the intensity of the symptoms may vary as per the health conditions, age, and other factors.  

So, to avoid the risk factors take precautions beforehand. You may ask a specialist for it.  

Red Man Syndrome: How to Treat It 

When the red rashes start appearing during or after the drug infusion, the doctor should immediately stop the process. Once it appears, it lasts for nearly 20 minutes. Well, in some cases, it lasts for more than 20 minutes-may be for an hour or two. So, in such cases, the doctor should wait until the symptoms go away. Even after the symptoms go away, the specialist should infuse the drug slowly. It may return back any time if not taken care of. 

The patient can also be given an oral dose of antihistamine. It will help to reduce the symptoms. But if a patient suffers from cases of hypotension, there may be a requirement for remedies like IV fluids, corticosteroids, etc. However, some medicines may be used before the infusion. It will help to prevent the syndrome from coming. If it is the case of surgical prophylaxis, severe hypotension may occur. In that case, therapy with a β-blocker before surgery can be helpful.  

Red Man Syndrome: Some Frequently Asked Questions 

We hope that the article has quenched your thirst for knowledge regarding red man syndrome. Let’s know some more details about it. It is one of the most common syndromes without any specific known cause. So, people’s minds are full of innumerable questions regarding it. We are sure you, too, have some in your mind. So, let’s know some of the frequently asked questions.  

Is vancomycin related to penicillin?  

Well, vancomycin can be used for patients who are allergic to penicillin. It is a proven remedy for the glycopeptides class bacteria like penicillin. The drug helps to prevent cell wall synthesis in susceptible bacteria. It has no proven side effects. So, it can be used safely for the patients. 

Can vancomycin cause anaphylaxis? 

Yes, just like red man syndrome, vancomycin can cause anaphylaxis. It is one of the hypersensitive syndromes caused by vancomycin. Simply put, it can occur all of a sudden, can worsen easily and can be fatal. Sometimes, it can be life-threatening. So, unlike red man syndrome, it has different medications to be treated.  

Is Red Man Syndrome life-threatening? 

Red Man Syndrome is not life-threatening, but it may lead to fatal consequences sometimes. It may affect the heart directly, causing cardiac arrest. As vancomycin may bring in the problems of kidney damage and loss of hearing, the troubles may get worse with the occurrence of Red Man Syndrome.  

Is Red Man Syndrome an allergy? 

The Red Man Syndrome cannot be considered as an allergy. But yes, it has allergic symptoms. It includes swollen skins and red rashes on the neck, face, and upper part of the body. The treatment for this is also a bit different from the anti-allergic treatments. So, let’s not confuse it with real allergies.  

Does Red Man Syndrome itch? 

Yes, red man syndrome does itch. As per the patients who suffered from it, it comes with a burning sensation or itching sensation. Although the symptoms of Red Man Syndrome are not too much serious, it irritates. However, it lasts for a short period of time. And it can be treated with antihistamines.  

How fast does Red Man Syndrome occur?  

If the first dose of vancomycin is put too quickly, the symptoms of Red Man Syndrome are likely to occur within 5 to 10 minutes. In some cases, the delayed reaction is seen.  

Can phenytoin cause red man syndrome?  

Till now, no case of Red Man Syndrome is reported when phenytoin and vancomycin are sued simultaneously with other drugs. 

Does Red Man Syndrome occur with oral vancomycin? 

Red Man Syndrome usually comes with the infusion of vancomycin. There is no such prominent case of the occurrence of Red Man Syndrome through oral administration. The syndrome is an idiopathic drug reaction. Although it looks like an allergy, it is not an allergy. Instead, you may call it a pseudo allergy.  

There was one fragment of the case of occurrence of Red Man Syndrome with oral vancomycin. An 82 years old lady developed red rashes after the use of oral vancomycin. The rash disappeared once the oral medication of the drug was stopped. 

Can vancomycin be given during pregnancy? Will it cause the Red Man Syndrome, then? 

If you are pregnant, the drug should be used only when prescribed. It may pass into breast milk. So, if you are given the drug, consult with a doctor before breastfeeding your baby.  

What should we do when we receive some unprecedented side effects? 

Not all of the side effects are discovered yet. You may have some kinds of unknown side effects. If you find any such side effects, you can easily report them at 1-800-FDA-1088. The update will directly go to the desk of the FDA. They will review it and update the information online accordingly.  

What is the proper dosage for vancomycin injection? 

If vancomycin is given to a patient in the right dosage, the risk of the occurrence of red man syndrome will reduce. So, the right dosage for it is 2 g 1 g in every 12 hours. 

How can vancomycin prevent the red man syndrome?  

Pre-treatment of the medicine with hydroxyzine can help to reduce erythema and pruritus. Also, the dosage of diphenhydramine may prevent the occurrence of red man syndrome. In this way, vancomycin may be used to prevent the syndrome from appearing.  

What is the other name for Red Man Syndrome? 

The other name for Red Man Syndrome is vancomycin flushing syndrome or VFS. Although people mostly call it Red Man Syndrome, it is also an important name for the disease.  

Is there any special reason why it is called Red Man Syndrome? 

No, there is no such particular reason—only the symptoms matter. The symptoms include red rashes on the neck, face, and upper body parts. So, from these symptoms, probably the name for Red Man Syndrome comes.  

What are the other serious side effects of vancomycin except for red man syndrome?  

The other side effects include ringing in the ear, change in urine, constant sore throat, diarrhea, etc. 

How does vancomycin work? 

Vancomycin has been known as the drug of last resort. It prevents the bacteria from building the cell walls. It binds to wall-building protein fragments known as peptides, especially those ending with two amino acid D-alanines.  

So, these are the frequently asked questions for Vancomycin and Red Man Syndrome. We hope that this section of the article has finally covered all of your doubts and queries regarding the syndrome.  

Bottom Line 

The emergence of a health issue while treating another issue is not uncommon in medical history. Most of the medicines have some side effects. Patients often see different reactions to different kinds of medications. Red Man Syndrome, therefore, is one such syndrome that occurs as a reaction to the anti-bacterial drug. Although we have discussed how it can be treated, it is better to take precautions before the trouble occurs. Instead of suffering the pain and discomfort and then going for the treatment, you can take some pretreatment prescribed by the experts.  

However, the syndrome may appear differently to different people. So, the patient suffering from such syndrome should be taken care of personally. If any more query you have regarding the syndrome and vancomycin drug, you can ask the expert. Or, you can leave your questions in the comment box below. We will be happy to hear from you. 

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