A role for vancomycin epicutaneous skin testing in the evaluation of perioperative anaphylaxis

Immune-mediated reactions to vancomycin

“…One patient had a positive skin test, that was defined by a wheal diameter of 3mm larger than the negative control to vancomycin (wheal 10 mm / flare 35 mm) using 50 mg/ml of vancomycin solution. 10 One patient had symptoms despite a red man syndrome protocol 20 . 21 Two patients were desensitized to vancomycin with breakthrough symptoms.…”

“…27 The current accepted skin testing protocol for IgE-mediated vancomycin allergy includes using a non-irritating concentration with skin prick concentration 50mg/mL and intradermal concentration 0.01 and 0.1 mcg/mL. 28,10 Although only one of our IgE-mediated HSRs to vancomycin cases used skin testing, other included cases had clinical courses that supports possible existence of an IgE mechanism; many had prior vancomycin exposure to account for sensitization and many failed red man syndrome protocols or desensitization. While severe red man syndrome is clinically indistinguishable from IgE-mediated anaphylaxis, IgE-independent reactions can often be overcome with premedication.…”

“…We excluded cases of ADRs that were possibly toxicities (e.g., cytopenias) and cases reporting immediate symptoms that were more likely red man syndrome than IgE. To distinguish from red man syndrome, and to be included in possible IgE-mediated HSR, cases of immediate reactions needed to have at least one of the following: (1) positive skin testing using a non-irritating concentration, 9,10 (2) immediate symptoms consistent with anaphylaxis 11 despite a red man syndrome protocol (slowed infusion and antihistamine premedication), 12,1314 or (3) symptoms consistent with IgE-mediated reaction during a vancomycin desensitization 15,16,17 .…”

Incidence of teicoplanin adverse drug reactions among patients with vancomycin-associated adverse drug reactions and its risk factors

“…Some studies demonstrated that several immunologic mechanisms may be related to vancomycin and teicoplanin hypersensitivity and their cross-reactivity. Both drugs can induce anaphylaxis via IgE-mediated hypersensitivity [23,27]. Asero [22] and Azamgarhi et al [23] revealed positive skin test results in patients with teicoplanin hypersensitivity.…”

“…The relationship between a specific reaction and the drug was assessed by the World Health Organization-Uppsala Monitoring Center causality assessment system; cases of 'certain' or 'probable' causality was considered as ADRs [20]. When AKI was the only adverse reaction after vancomycin use, the case was not considered as a hypersensitivity reaction because vancomycin-induced AKI is not an immune-mediated response [21] and typically differs from other type of vancomycin associated ADRs that might be immune-mediated hypersensitivity reaction [22][23][24][25][26][27][28]. All assessments were cross-checked separately by two allergists in the drug allergy clinic.…”