title: Red man syndrome: incidence, etiology, and prophylaxis.
abstract: The red man syndrome (RMS) is the most common toxicity of vancomycin therapy. A prospective trial to investigate the frequency, causation, and possible prophylaxis of this syndrome was conducted. Thirty-three patients were observed during their first two doses (1 g/60 min) of vancomycin. Before dose 1, they were randomized to double-blinded pretreatment with either diphenhydramine (50 mg) or placebo. Patients were examined frequently, and histamine levels were obtained at 0, 30, and 60 min during dose 1. Those with first-dose reactions were rerandomized for pretreatment and had histamine levels drawn during a second infusion. Of 17 patients with placebo pretreatment, 8 (47%) had RMS. None of the 16 pretreated with diphenhydramine had a first-dose reaction (P = .003). Three of the eight first-dose reactors had a second-dose RMS reaction; in one of these three, it was more severe than the dose 1 RMS despite diphenhydramine pretreatment. RMS events were associated with elevated plasma histamine; this was especially true of severe reactions.
authors.affiliation: Department of Internal Medicine (Infectious Disease Division), Naval Hospital, San Diego, California 92134-5000.
authors.forename: M R
authors.initials: MR
authors.lastname: Wallace
authors.forename: J R
authors.initials: JR
authors.lastname: Mascola
authors.forename: E C
authors.initials: EC
authors.lastname: Oldfield
mesh_terms: D000328:Adult; D004155:Diphenhydramine / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005483:Flushing / Q000139:chemically induced* / Q000517:prevention & control; D006632:Histamine / Q000097:blood; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced* / Q000517:prevention & control; D013577:Syndrome; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D014640:Vancomycin; D006632:Histamine; D004155:Diphenhydramine