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Immunoglobulin E-mediated hypersensitivity reaction after intraperitoneal administration of vancomycin
Mun-Ju Hwang1, Jun-Young Do1, Eun-Woo Choi1
1Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
Kidney Research and Clinical Practice
|October 21, 2015
Summary
This study reports the first case of an immunoglobulin E-mediated hypersensitivity reaction to intraperitoneal vancomycin in a peritoneal dialysis patient. This finding is crucial for understanding vancomycin allergy in dialysis patients.
Area of Science:
- Nephrology
- Clinical Immunology
- Pharmacology
Background:
- Intraperitoneal vancomycin is a standard treatment for Gram-positive peritonitis in peritoneal dialysis patients.
- While red man syndrome (RMS) is a known non-immunologic reaction to vancomycin, immune-mediated hypersensitivity has not been previously reported with intraperitoneal administration.
- This case highlights a potential, distinct adverse reaction to this common treatment.
Purpose of the Study:
- To report the first case of immunoglobulin E (IgE)-mediated hypersensitivity reaction to intraperitoneal vancomycin.
- To document the clinical presentation and diagnostic findings of this rare adverse event.
- To raise awareness among clinicians regarding potential vancomycin hypersensitivity in peritoneal dialysis patients.
Main Methods:
- A case report of a 49-year-old female on continuous ambulatory peritoneal dialysis (CAPD) who developed symptoms after intraperitoneal vancomycin treatment for peritonitis.
- Clinical observation of symptoms including itching, flushing, and urticaria following vancomycin administration.
- Performance of an intradermal skin test to confirm vancomycin hypersensitivity.
Main Results:
- The patient experienced progressive symptoms of generalized urticaria and prickling sensation after each vancomycin dose, which resolved upon discontinuation.
- An intradermal skin test revealed a positive response to vancomycin, indicating an allergic reaction.
- This is the first documented instance of IgE-mediated hypersensitivity to intraperitoneal vancomycin.
Conclusions:
- Intraperitoneal vancomycin can cause true allergic hypersensitivity reactions, distinct from red man syndrome.
- Clinicians should consider IgE-mediated hypersensitivity in peritoneal dialysis patients presenting with urticarial reactions during vancomycin treatment.
- Further investigation may be warranted to understand the prevalence and mechanisms of vancomycin hypersensitivity in this population.
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