Perioperative anaphylaxis to intravenous vancomycin in a pediatric patient with previous topical exposures

Abstract

Vancomycin is a glycopeptide antibiotic often implicated in hypersensitivity reactions. Immunoglobulin E (IgE)–mediated anaphylaxis to vancomycin is rare, and vancomycin is more frequently described as causing “red man syndrome”—characterized by immediate-onset erythema, pruritus, and sometimes hypotension—secondary to non–IgE-mediated histamine release (ie, by Mas-related G protein-coupled receptor-X2).1,2 A recent systematic review of vancomycin hypersensitivity identified only 7 cases of presumed IgE-mediated reactions, none of whom were children.