Immunoglobulin E-mediated hypersensitivity reaction after intraperitoneal administration of vancomycin

Immunoglobulin E-mediated hypersensitivity reaction after intraperitoneal administration of vancomycin

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Intraperitoneal (IP) vancomycin is widely used to treat Gram-positive peritonitis associated with peritoneal dialysis.There have been two cases Dice of red man syndrome (RMS), a vancomycin-specific nonimmunologic reaction, associated with IP vancomycin.However, immune-mediated hypersensitivity reaction to IP vancomycin has not yet been reported.A 49 year old woman on continuous ambulatory peritoneal dialysis developed her first peritonitis episode.The patient was treated with IP vancomycin once/wk for 4 weeks.

She experienced mild itching and flushing throughout her body for 1 day after the second treatment.Whenever vancomycin was administered, generalized urticaria and a prickling sensation developed, and the intensity increased gradually; however, these symptoms improved after vancomycin was discontinued.An allergic skin test was performed 6 weeks after the previous urticarial episode, and an intradermal skin test revealed a positive response to vancomycin.To our knowledge, this is the Hoodie first case report of immunoglobulin E-mediated hypersensitivity reaction to IP vancomycin administration.