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Defining risk factors for red man syndrome in children and adults

Angela L Myers1, Andrea Gaedigk, Hongying Dai

  • 1Department of Pediatrics, Medical Research, Children's Mercy Hospitals and Clinics and the University of Missouri-Kansas City, Kansas City, MO 64108, USA. amyers@cmh.edu

The Pediatric Infectious Disease Journal
|February 14, 2012
PubMed

Insights

Red man syndrome (RMS) is a common adverse reaction in children receiving vancomycin. Risk factors include Caucasian ethnicity, older age, prior RMS, and higher vancomycin doses, while African American race is protective.

Area of Science:

  • Pediatric Pharmacology
  • Clinical Toxicology
  • Pharmacovigilance

Background:

  • Red man syndrome (RMS) is a known vancomycin adverse reaction in children, but its prevalence, characteristics, and risk factors remain unclear.
  • Understanding these factors is crucial for safe vancomycin administration in pediatric populations.

Purpose of the Study:

  • To determine the prevalence, characteristics, and risk factors for RMS in pediatric patients receiving vancomycin.
  • To investigate potential contributing genetic factors to RMS development.

Main Methods:

  • A multicenter retrospective study involving 546 pediatric patients (0.5-21 years) who received intravenous vancomycin.
  • Data collection included chart reviews and parent/nurse reports for demographic and symptom data.
  • Genotype analysis focused on single nucleotide polymorphisms within the histamine pathway.

Main Results:

  • RMS occurred in 14% of pediatric vancomycin recipients.
  • Common symptoms included rash, pruritus, and flushing without hypotension.
  • Identified risk factors: Caucasian ethnicity, age > 2 years, prior RMS, higher vancomycin dose/concentration, and antihistamine use. African American race was protective.
  • No significant association found between RMS and genetic variants in the histamine pathway.

Conclusions:

  • Red man syndrome is a frequent adverse event in children treated with vancomycin.
  • Key risk factors identified include Caucasian ethnicity, age, prior RMS, and vancomycin administration parameters.
  • Genetic factors within the histamine pathway do not appear to be major contributors to RMS risk in this population.
Abstract

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