Cross Reactivity: Separating Fact from Theory in Vancomycin-Related Reactions

When it comes to understanding the relationship between vancomycin and other structurally related drugs, it is crucial to distinguish between pharmacological and immunological cross-reactivity. While both types of reactions involve shared interactions or similar structures, they are driven by distinct mechanisms.

Pharmacological cross-reactivity occurs when a drug interacts with a known receptor, whereas immunological cross-reactivity involves an adaptive immune response recognizing a shared epitope. In the case of vancomycin, previous reports have suggested a lack of cross-reactivity with dalbavancin based on IgE-mediated reactions and negative ingestion challenges. However, it is likely that these reactions were actually driven by non-IgE mediated mechanisms associated with vancomycin.

In particular, delayed hypersensitivity reactions linked to vancomycin are thought to involve immunological cross-reactivity, but there is limited evidence of such reactivity between vancomycin and other glycopeptides. A recent study found no association between teicoplanin and the development of non-IgE mediated mast cell activation, also known as red man syndrome. This is in contrast to vancomycin, which can induce mast-related G-protein coupled receptor 2 (MRGPRX2) driven induction of LAD2 mast cell degranulation.

Some researchers have proposed the theoretical possibility of cross-reactivity between vancomycin and other glycopeptides due to structural similarity. However, notable differences in these drugs' chemical structures suggest that such reactivity is unlikely.

In a recent editorial, Kayode and Rutkowski highlighted several important points about the broad range of immediate and delayed hypersensitivity reactions occurring in association with vancomycin. The authors emphasized the need for further research into the mechanisms underlying these reactions to better understand and manage them.

Ultimately, understanding cross reactivity between vancomycin and other structurally related drugs requires a nuanced approach that takes into account both pharmacological and immunological mechanisms. By distinguishing between fact and theory, healthcare professionals can provide more effective treatment and management strategies for patients experiencing adverse reactions to these medications.

Cross reactivity