What is Vancomycin Flushing Syndrome?
Vancomycin flushing syndrome (VFS) is a reaction similar to an allergy, triggered by the quick introduction of the antibiotic named vancomycin into the body. VFS generally includes an itchy, red rash on the face, neck, and upper body, and could also affect the limbs mildly. Additional symptoms may be feeling weak, swelling of body parts, and experiencing pain in the chest or back. This reaction is due to vancomycin triggering the release of a substance known as histamine from cells called mast cells and basophils which are involved in immune responses.
The volume of histamine released typically depends on the amount of vancomycin introduced and how quickly it was administered. VFS is usually connected with quicker administration rates, but it can also be seen with slower rates and even after several days of treatment. It’s vital for those administering vancomycin to know about this potential reaction – how to prevent it, recognize it, and negate it.
What Causes Vancomycin Flushing Syndrome?
Red Man Syndrome (RMS) often occurs when intravenous vancomycin – a type of antibiotic – is administered. However, it can sometimes occur from taking the medication orally or it being placed directly into the abdomen. It’s commonly associated with giving the medication too quickly (1 gram in less than 1 hour). To avoid RMS, it’s recommended that vancomycin be given slowly – no faster than 1 gram per hour or 10 mg per minute.
Symptoms of RMS usually start 4 to 10 minutes after the start of the first dose. It may also occur later during medication delivery or shortly after it has finished. RMS can also occur after later doses, even as long as seven days later.
There’s been an increase in certain bacteria that are resistant to many antibiotics, including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, and Clostridium difficile. Because of this, there’s been a rise in the use of vancomycin. It is often used to treat endocarditis (infection of the inner lining of your heart), abscesses (pockets of pus) with skin inflammation, infections after surgery, infections of surgically placed devices, and bloodstream infections associated with a central line (a long-term catheter placed into a large vein).
There are cases where RMS has occurred from other antibiotics including rifampin, cefepime, teicoplanin, ciprofloxacin, and amphotericin B.
Risk Factors and Frequency for Vancomycin Flushing Syndrome
VFS, or ‘Vancomycin Flushing Syndrome’, is a common side effect seen in many patients treated with an antibiotic called intravenous vancomycin. This effect can happen to anywhere between 4% to 50% of patients receiving this treatment. People under 40 are most likely to experience severe reactions from VFS.
Severe symptoms of VFS can include swelling under the skin, low blood pressure, fast heartbeat, weakness, muscle spasms, and pain in the chest or back. In addition, some people may get a rash on their face, neck, and upper body. While VFS is usually mild and can be managed easily, there are a few extreme cases where it can pose a serious threat to one’s life.
Signs and Symptoms of Vancomycin Flushing Syndrome
Red Man Syndrome, also known as Vancomycin Flushing Syndrome (VFS), is a condition with varying symptoms that can arise after taking certain medications, in particular, vancomycin. These symptoms can range from mild itchiness to more severe and potentially life-threatening conditions. They can start as soon as four minutes after starting the medication and in some cases can last up to seven days after stopping it. The signs of this syndrome include:
- Redness on the face, neck, and upper chest
- Nausea and vomiting
- Itchy skin
- Low blood pressure
- Fever and chills
- Weakness and dizziness
- Chest or back pain, muscle spasms in the trunk of the body
- Swelling under the skin, often around the mouth or eyes
- A fast heartbeat
- Rashes on the limbs; however, these are usually less severe than the redness on the face, neck, and upper chest
People who are treated with intravenous vancomycin for an infection are at risk of developing VFS.
Testing for Vancomycin Flushing Syndrome
Voynow-Fountain syndrome (VFS) is normally diagnosed through physical tests and health check-ups by a doctor, there’s usually no need for lab tests or any other tests. However, in severe cases, it’s important for doctors to check if the symptoms are indeed due to VFS or they are a result of other serious immune system reactions, known as IgE-mediated anaphylactic reactions. People with anaphylaxis have excessive and harmful immune responses that need immediate attention.
Treatment Options for Vancomycin Flushing Syndrome
If you are experiencing symptoms of Vancomycin Flushing Syndrome (VFS), a reaction to a specific antibiotic, the infusion of this medication via IV will be stopped immediately, and you will be provided with supportive care. Doctors often use anti-allergy medicines, known as antihistamines (diphenhydramine and cimetidine), to manage VFS. In most cases, if future doses of vancomycin are necessary, they may be given slowly.
If you have mild symptoms like light facial flushing and mild itching, these can often be managed with the mentioned antihistamines such as diphenhydramine and cimetidine, which could be given either orally or intravenously. Usually, the symptoms stop within 20 minutes and the vancomycin can be restarted with a slower infusion rate. Caregivers will then introduce future doses at this slower rate, typically over a period of two hours.
If you have moderate to severe symptoms such as a severe rash, low blood pressure, rapid heartbeat, chest pain, back pain, muscle spasm, weakness, and swelling beneath the skin (angioedema), you’ll be thoroughly assessed to ascertain whether these are due to VFS or another condition. After careful evaluation, if they find out it’s due to VFS, they can intravenously administer antihistamines and provide fluids via IV to treat low blood pressure. Once your symptoms are under control, the vancomycin can be reintroduced slowly over four hours. If suitable, other antibiotics could be used as an alternative to vancomycin. They might also give you the antihistamines ahead of each vancomycin dose to prevent a VFS reaction.
If you show signs of a severe allergic reaction known as anaphylaxis, such as confusion, low blood pressure, difficulty breathing, wheezing, and development of hives, immediate medical emergency treatment will be necessary. This situation requires the administration of epinephrine, a medication used to treat severe allergic reactions, which you might already have in the form of an auto-injector.
Lastly, if you require a rapid dosage of vancomycin, your healthcare team can give you antihistamines beforehand to prevent VFS. Regardless, the best practice to avoid VFS is keeping the rate of vancomycin infusion below 10 mg per minute.
What else can Vancomycin Flushing Syndrome be?
It’s important to distinguish between VFS (vancomycin flushing syndrome) and a severe allergic reaction known as an anaphylaxis. Both of these reactions can cause itching, redness, and a fast heart rate. However, an anaphylactic reaction also includes symptoms like harsh, grating sounds when breathing (stridor), swelling in deeper layers of the skin (angioedema), hives, and wheezing due to constriction of lung airways (bronchospasm).
Moreover, anaphylactic reactions are typically triggered by specific allergens and need prior exposure to that allergen. This is facilitated through a type of antibody called IgE. On the other hand, VFS is a type of non-allergic reaction that can often occur during the first time a person is given the medicine vancomycin via injection.
What to expect with Vancomycin Flushing Syndrome
The outlook for patients with VFS, or red man syndrome, is generally very good, especially with the right management strategies. Even after an episode of VFS, Vancomycin – the antibiotic that usually causes this syndrome, can still be used again. However, it’s important to follow certain precautions and guidelines for treatment.
If a patient experiences low blood pressure (also known as hypotension), it can be managed using normal salt water delivered via an intravenous line, a small tube inserted into a vein. In addition, other supporting treatments may be provided to help take care of the patient and ease their symptoms.
Possible Complications When Diagnosed with Vancomycin Flushing Syndrome
Vancomycin flushing syndrome (VFS) is a reaction to certain antibiotics like Vancomycin. It occurs when these antibiotics trigger the release of histamine – a compound involved in immune responses – from certain types of white blood cells. This reaction can cause symptoms such as a red rash, low blood pressure, rapid heartbeat, and swelling under the skin. Although the majority of these instances can be managed, there are some that could be seriously harmful, even life-threatening.
Symptoms of Vancomycin Flushing Syndrome:
- Red rash
- Low blood pressure
- Rapid heart rate
- Swelling under the skin
Preventing Vancomycin Flushing Syndrome
It’s important for health professionals to understand the signs of a condition known as “vancomycin flushing syndrome” (VFS), and how to manage it, as this can make a big difference in patient recovery. Vancomycin is a type of antibiotic, and VFS is a reaction that some people may have to this medication, which includes symptoms like feeling warm and turning red. If you’re receiving this medication, your healthcare providers should make sure you’re getting the best treatment possible and help you understand more about the condition. This education is vital for ensuring a swift and smooth recovery.
