Journal of Clinical Immunology

, Volume 39, Issue 8, pp 855–856 | Cite as

Serum Tryptase Cannot Differentiate Vancomycin-Induced Anaphylaxis From Red Man Syndrome

  • Satoko Noguchi
  • Daiki Takekawa
  • Junichi SaitoEmail author
  • Eiji Hashiba
  • Kazuyoshi Hirota
Letter to Editor

To the Editor:

Perioperative anaphylaxis is a life-threatening event and requires prompt recognition and treatment to ensure a good outcome. Vancomycin can induce nonspecific direct stimulation of mast cells, resulting in histamine release and the anaphylactoid reaction known as “red man syndrome” [1]. Red man syndrome and anaphylaxis share a number of signs and symptoms, and thus differential diagnosis is difficult in some cases. Nonetheless, differential diagnosis between these conditions is crucial, since a diagnosis of anaphylaxis to vancomycin reduces the options for treatment of life-threatening infections such as infective endocarditis, severe pneumonia, and sepsis. Measurement of the serum tryptase concentration is considered useful to distinguish between red man syndrome and anaphylaxis [2]. However, we here report the case of a patient diagnosed as having anaphylaxis induced by intravenous vancomycin usage based on increased plasma tryptase concentration, despite a clinical...


Authors’ Contribution

All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

The authors have obtained written informed consent from the patient for publication.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyHirosaki University Graduate School of MedicineAomoriJapan
  2. 2.Division of Intensive Care UnitsHirosaki University HospitalAomoriJapan

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