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Red man syndrome

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Presentation 
Cutaneous wheals and urticaria
Local phenomenon 
Progression to anaphylaxis : rare 

Mechanism 
De granulation of mast cells : direct action 

Drugs implicated 
Vancomycin 
Ciprofloxacin 
Amphotericin B 
Rifampicin
Teicoplanin
Cremophor : excipient in paclitaxel & cyclosporine 

Management 
For vancomycin 
Slowing infusion rate or stopping
Prophylactic use of antihistamines 
Repeated administration : tolerance can develop. 

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