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RMS Not True Allergy — SCE Infectious Diseases MCQ

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EasyInfection Prevention & ControlRMS Not True AllergySCE Infectious Diseases

A 55-year-old man develops a deep sternal wound infection after CABG. Wound cultures grow MRSA. He has a documented Vancomycin allergy (Red Man Syndrome — infusion reaction). Can Vancomycin still be used?

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Correct answer: C — Yes — Red Man Syndrome is NOT true allergy; it is a histamine-mediated infusion reaction managed by slowing the infusion rate and pre-medicating with antihistamine; Vancomycin can be safely continued

Red Man Syndrome is caused by direct histamine release from mast cells triggered by rapid Vancomycin infusion. It is NOT IgE-mediated true allergy. Management: (1) slow infusion rate (≥2 hours per dose), (2) pre-medicate with IV Chlorphenamine 30-60 minutes before infusion. With these measures, >95% of patients tolerate Vancomycin safely. Mislabelling RMS as true allergy permanently deprives patients of Vancomycin — an important antimicrobial stewardship issue. True Vancomycin allergy (anaphylaxis, SJS/TEN, DRESS) is rare and DOES contraindicate re-exposure.

Reference: BNF 2024 – Vancomycin; BSAC 2023 – Allergy delabelling