UMEM Educational Pearls

 Vancomycin infusion reactions can manifest as pruritus and an erythematous rash of the neck, face, and torso during or after a vancomycin infusion.  This is a histamine reaction caused by degranulation of mast cells and basophils, and can be caused short infusion times <60 min.  It is commonly treated with antihistamines and/or a slowing of the infusion rate. 

Historically, this has been called “Red Man Syndrome.”  As we move towards more inclusive language in medicine, it is increasingly necessary to remove language that is insensitive and/or offensive.  Not only is “Red Man Syndrome” offensive towards Native Americans, it also is an inaccurate term that implies a clinical presentation in white male patients when this reaction can occur in any race or gender. 
The preferred terminology is now “vancomycin infusion reaction” or “vancomycin flushing reaction” and is supported by physician, pharmacist, and pediatric professional publications.    
Allergy documentation matters.  Always include descriptors of the reaction to avoid labeling patients “vancomycin allergic” if it truly was an infusion reaction as this can lead to suboptimal second line therapy being unnecessarily selected.  
What you can do:
1.       Replace “Red Man Syndrome” with vancomycin infusion reaction in your teaching and vernacular
2.       Remove “Red Man Syndrome” from patient allergies and replace with Vancomycin Infusion Reaction with a short description of what the patient experienced
3.       Avoid using “Red Man Syndrome” in your future scholarly works and publications


1.       Rivera CG, Ryan KL. Call to Pharmacists: End Use of “Red Man Syndrome.” Annals of Pharmacotherapy. May 2021. doi:10.1177/10600280211021417
2.       Alvarez-Arango, S, Ogunwole, SM, Sequist, TD, Burk, CM, Blumenthal, KG. Vancomycin infusion reaction—moving beyond “red man syndrome.” N Engl J Med. 2021;384:1283-1286. doi:10.1056/NEJMp2031891
3.       Austin, JP, Foster, BA, Empey, A. Replace red man syndrome with vancomycin flushing reaction. Hosp Pediatr. 2020;10:623-624. doi:10.1542/hpeds.2020-0125