A role for vancomycin epicutaneous skin testing in the evaluation of perioperative anaphylaxis

Interestingly, it has been shown that although serum histamine levels rise during vancomycin reactions due to nonspecific direct mast cell stimulation, serum tryptase levels stay unchanged.8 Furthermore, this patient's clinical history was consistent with perioperative anaphylaxis, indicating that her elevated tryptase was due to IgE-mediated HSR. Current guidelines recommend that vancomycin be considered for perioperative antimicrobial prophylaxis in patients with a known methicillin-resistant Staphylococcus aureus (MRSA) colonization, in patients at high risk for MRSA colonization, and at institutions with high rates of postoperative or surgical site MRSA infections.3 A diagnostic test to evaluate vancomycin HSR will become essential as the number of MRSA infections continues to rise in the United States,9 creating a growing need for vancomycin use in health care settings.