Desensitization protocols for vancomycin hypersensitivity

OBJECTIVE: To discuss the pathophysiology of vanomycin-induced immediate hy persensitivity reactions, review of process of vancomycin desensitization, and provide specific directions for ordering and preparing rapid and slow d esensitization protocols. DATA SOURCES: A MEDLINE search (1996-February 2001) of English-language lit erature pertaining to vancomycin desensitization and hypersensitivity react ions was performed. Tertiary sources were also used. DATA EXTRACTION: Published clinical studies and case reports. DATA SYNTHESIS: The pathophysiology of vancomycin-induced hypersensitivity reactions is discussed along with the procedure of vancomycin desensitizati on. Desensitization should be considered in Red Man syndrome (RMS) that doe s not respond to the usual treatment measures, and in vancomycin-induced an aphylaxis. Rapid desensitization is preferred as it is effective in the maj ority patients and enables therapeutic dosing of vancomycin within 24 hours . In patients who fail rapid desensitization, a slow desensitization protoc ol may be tried. CONCLUSIONS: Vancomycin-induced immediate hypersensitivity reactions includ e RMS and anaphylaxis. Vancomycin desensitization should be considered for severe RMS reactions not responding to usual measures and in anaphylactic r eactions to vancomycin when substitution of another antibiotic is not feasi ble.