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Table 2 Mechanisms and manifestations of Vancomycin hypersensitivity

From: Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy

Mechanisms Type of reaction based on the time of onset Main manifestations due to vancomycin
Non-immunological mechanism Mast cell and basophil histamine release Immediate reaction Red man syndrome
Immunological mechanisms Type I Immediate reaction Anaphylaxis
Type II Non-immediate reactions Nephritis
Type III Non-immediate reactions Vasculitis*
Type IVa Non-immediate reactions Exfoliative dermatitis
Type IVb Non-immediate reactions Maculo-papular exanthema, DRESS/DiHS
Type IVc Non-immediate reactions SJS/TEN, hepatitis
  Type IVd Non-immediate reactions AGEP
  1. *Unproven.