Histamine release during rapid vancomycin administration
Rapid administration of vancomycin induces red-man syndrome (RMS), characterised by rash (on the face, neck and torso), pruritus, and hypotension, attributed to histamine release [1–3]. Vancomycin stimulates histamine release by a chemically mediated anaphylactoid reaction [4]. The incidence of RMS can be reduced by infusion over 1 h which may be impractical in urgent clinical situations or ambulatory care. Other drug-induced, chemically mediated, anaphylactoid reactions can be attenuated by chemoprophylaxis with antihistamines [5–7]. The extent to which the manifestations of RMS are histamine-mediated has not been clearly established. We performed a prospective, randomised, double-blind, placebo-controlled study to investigate the correlation of RMS and histamine release and the ability of H1 and H2 antihistamines to attenuate RMS associated with rapid vancomycin administration.