X Red Neck Syndrome (RNS) is a side effect that can occur with the antibiotic vancomycin. It’s an infusion-related reaction, meaning it’s caused by the way the medicine is administered, typically when given rapidly through an IV.
Symptoms
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Flushing and/or erythematous rash: A prominent red rash usually involving the face, neck, and upper torso.
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Itching (pruritus)
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Hypotension (low blood pressure): Can lead to dizziness or fainting
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Angioedema (swelling): Less common, but may affect the face, lips, and airways.
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Other Symptoms: Back/chest pain, chills, weakness
Causes
RNS is caused by the direct release of histamine from mast cells (a type of immune cell) due to vancomycin. The faster the vancomycin is infused, the more likely and severe the reaction.
Prevention
The best way to prevent RNS is to infuse vancomycin slowly:
- Standard Infusion Rate: The drug is diluted and given over at least 60 minutes.
- Very Slow Infusion: In people with prior reactions, even slower infusion rates may be used.
Treatment
Most cases of RNS are mild and resolve on their own when the vancomycin infusion is stopped. In more severe cases:
- Antihistamines: Help counteract the effects of histamine
- Fluids: Can help if there’s significant low blood pressure.
- Stopping and Restarting: The infusion may be stopped temporarily and then restarted at a slower speed.
Important Considerations
- Not a True Allergy: RNS is not an allergic reaction to vancomycin in the traditional sense. It’s an infusion-related side effect.
- Can Still Receive Vancomycin: Even if you’ve had RNS, you can usually still receive vancomycin with slower infusion rates or pre-treatment with antihistamines.
- Tell Your Doctor: If you’ve ever had RNS, let your doctor know before receiving vancomycin again.