---
title: "Replace the term “red man syndrome” with vancomycin infusion reaction in clinical use"
id: "cmaj-5-red-man-syndrome-should-never-be-used-to-describe-vancomycin-infusion-reaction"
canonical_url: "https://medichelpline.com/clinical-feed/cmaj-5-red-man-syndrome-should-never-be-used-to-describe-vancomycin-infusion-reaction"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CMAJ"
source_url: "http://www.cmaj.ca/cgi/content/short/198/28/E1116?rss=1"
published_at: "2026-08-10T04:05:21.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Replace the term “red man syndrome” with vancomycin infusion reaction in clinical use
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cmaj-5-red-man-syndrome-should-never-be-used-to-describe-vancomycin-infusion-reaction
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CMAJ
- **Source URL:** [Original Journal Publication](http://www.cmaj.ca/cgi/content/short/198/28/E1116?rss=1)
- **Published At:** 2026-08-10T04:05:21.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The term **“red man syndrome”** is an outdated, racist phrase historically used to describe a vancomycin infusion reaction and should be abandoned in clinical, educational, and administrative settings. - **Vancomycin infusion reaction** is an idiopathic, non–IgE-mediated anaphylactoid reaction caused by endogenous histamine release from mast cells, first described in 1959. - Clinical features include flushing, erythema, warmth (especially upper torso, neck, face), pruritus, myalgias, dyspnea, and hypotension. - The label “red man” reinforces racism toward **Indigenous** Peoples and has been a racial slur in North America since the 1600s; medicine has been slow to stop using it. - Despite US medical societies issuing a 2021 joint statement advising abandonment of the term, the phrase remains in use in Canada in hospitals, home-care guidance, and national safety documents. - Recommended neutral alternatives include **vancomycin infusion reaction** or vancomycin flushing reaction/syndrome, which are descriptive and respectful. - Canadian organizations and professional societies should adopt nondiscriminatory language, update guidelines, teaching materials, product monographs, clinical decision tools, electronic records, and adverse-event databases. - Education across all levels and enabling automatic substitution in electronic medical records can reduce use: one US study found 62% of vancomycin-related “allergic” entries used the offensive term and that educational interventions plus auto-substitution reduced usage by roughly 20% over five months. - Given that about 5% of Canada’s population self-identifies as Indigenous (and higher proportions in some provinces and majority in the territories), removing racist terminology supports culturally safe care and reconciliation. - Authors call on Canadian bodies (medical societies, schools, regulatory agencies) to immediately cease using the term and to require curricular audits and documentation changes to promote culturally safe practice.
## Clinical Analysis & Structured Key Points
“Red man syndrome” should never be used to describe vancomycin infusion reaction | CMAJ Skip to main content Log in Toggle navigation menu Open settings menu Open search Advanced Search Advanced Search Log in --> “Red man syndrome” should never be used to describe vancomycin infusion reaction Sergio T. Fanella Sergio T. Fanella Department of Pediatrics and Child Health (Fanella), University of Manitoba Max Rady College of Medicine; WRHA Pharmacy Program (Walus), Winnipeg Regional Health Authority, Winnipeg, Man.; Leslie Dan Faculty of Pharmacy (Swidrovich), University of Toronto, Toronto, Ont.; Clinical Pharmacy Services (Spina), Vancouver Island Health Authority, Victoria, BC; Faculty of Pharmaceutical Sciences (Spina), University of British Columbia, Vancouver, BC. MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ashley N. Walus Ashley N. Walus Department of Pediatrics and Child Health (Fanella), University of Manitoba Max Rady College of Medicine; WRHA Pharmacy Program (Walus), Winnipeg Regional Health Authority, Winnipeg, Man.; Leslie Dan Faculty of Pharmacy (Swidrovich), University of Toronto, Toronto, Ont.; Clinical Pharmacy Services (Spina), Vancouver Island Health Authority, Victoria, BC; Faculty of Pharmaceutical Sciences (Spina), University of British Columbia, Vancouver, BC. BScPharm MBA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jaris P. Swidrovich Jaris P. Swidrovich Department of Pediatrics and Child Health (Fanella), University of Manitoba Max Rady College of Medicine; WRHA Pharmacy Program (Walus), Winnipeg Regional Health Authority, Winnipeg, Man.; Leslie Dan Faculty of Pharmacy (Swidrovich), University of Toronto, Toronto, Ont.; Clinical Pharmacy Services (Spina), Vancouver Island Health Authority, Victoria, BC; Faculty of Pharmaceutical Sciences (Spina), University of British Columbia, Vancouver, BC. PharmD PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site and Sean P. Spina Sean P. Spina Department of Pediatrics and Child Health (Fanella), University of Manitoba Max Rady College of Medicine; WRHA Pharmacy Program (Walus), Winnipeg Regional Health Authority, Winnipeg, Man.; Leslie Dan Faculty of Pharmacy (Swidrovich), University of Toronto, Toronto, Ont.; Clinical Pharmacy Services (Spina), Vancouver Island Health Authority, Victoria, BC; Faculty of Pharmaceutical Sciences (Spina), University of British Columbia, Vancouver, BC. PharmD Find this author on Google Scholar Find this author on PubMed Search for this author on this site CMAJ August 10, 2026 198 (28) E1116-E1117; DOI: https://doi.org/10.1503/cmaj.251714 PDF Help Article Responses Metrics PDF Key points Vancomycin infusion reaction is an idiopathic, nonimmunoglobulin E-mediated anaphylactoid reaction that results in endogenous histamine release from mast cells. The reaction was once referred to as “red man syndrome” because manifestations include flushing that shows red in those who are White, but this term has long been used as a racial slur toward people of Indigenous decent in North America and is not acceptable. Several medical societies in the US issued a statement that the offensive term should no longer be used; however, the term is still encountered and continues to be used in Canada. Education at all levels, and facilitating auto-substitution of appropriate terminology in records can be effective in driving change. All organizations and professional societies in Canada that communicate about vancomycin infusion reaction should make their members aware of the appropriate terminology, ensure that the outdated term is no longer used, and modify existing documents as needed. A 1985 New England Journal of Medicine case report has been cited as the first to use the term “red man syndrome” in the medical literature when describing a vancomycin infusion reaction. 1 Unfortunately, this racist term continues to be used, and it is long past time that the term is abandoned entirely in Canada. Vancomycin infusion reaction — an idiopathic, nonimmunoglobulin E-mediated anaphylactoid reaction that results in endogenous histamine release from mast cells — was first described in 1959. 2 Manifestations include flushing, erythema, warmth (especially of the upper torso, neck, and face), pruritus, myalgias, dyspnea, and hypotension. The term “red man” in this context is more than just the visual description of a change in the skin colour of a person who is White and a man. These words reinforce racism toward Indigenous Peoples. They have been used as a racial slur since the 1600s and have been long used in popular culture, whether in songs, children’s movies, or as names of professional or university sports teams. 3 In contrast to other contexts, medicine has been slow to stop using this offensive term. Our experience as pharmacists and an infectious disease specialist is that this outdated term for vancomycin infusion reaction is still used commonly in Canada. For instance, an Internet search revealed examples of its use by hospitals, a provincial home care agency, and a national organization focused on medication safety. 4 – 7 In the United States, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, the Society for Healthcare Epidemiology of America, the Society for Infectious Diseases Pharmacists, and the HIV Medicine Association issued a joint statement in 2021 saying that the term should no longer be used, as has the American Academy of Pediatrics. 8 These have suggested that terms such as vancomycin infusion reaction or vancomycin flushing reaction or syndrome (which was originally proposed in the syndrome’s first description in 1959) 2 be used instead. Such terms are descriptive, assist in recognition of the spectrum of skin manifestations in diverse populations, and are also respectful. We are not aware of similar calls by Canadian organizations and, given the continued use of “red man syndrome” in Canada, we are issuing such a call. Adopting nondiscriminatory language is a critical step toward fostering culturally safe care environments and advancing reconciliation within Canada’s health care systems. Our organizations recommend the term never be used and be replaced with vancomycin infusion reaction in all settings — clinical, educational, and administrative — regardless of whether communication is verbal, written, or electronic. Teaching materials, clinical decision support tools, guidelines and position statements, clinical pharmacy databases, and databases used to record medication adverse events should be modified accordingly. Education at all levels and of all involved parties can be effective in driving change. For example, a recent study from the United States found that 62% of vancomycin-related “allergic” events in medical records identified by an antimicrobial stewardship team used the offensive terminology. Five months after educational interventions and the ability to auto-substitute terminology in electronic medical records, its use declined by about 20%. 9 Around 5% of the population in Canada self-identify as Indigenous, with the proportion reaching 20% in some provinces; in the territories, Indigenous Peoples make up the majority. 10 Learners in Canada can be taught about the pathophysiology and consequences of vancomycin infusion reaction, but vancomycin infusion reaction can also be used as an opportunity to discuss the historical context in which Indigenous Peoples have encountered systemic racism within Canada’s health care systems. Clinical, administrative, and educational organizations in Canada all share responsibility for eliminating the use of the term “red man syndrome.” All organizations and professional societies that write or communicate about vancomycin infusion reaction should make its members aware of the appropriate terminology, ensure that outdated terms are no longer used, and modify existing documents as needed. Such bodies include, but are not limited to, the Canadian Society of Internal Medicine, the Canadian Paediatric Society, the College of Family Physicians of Canada, the Association of Medical Microbiology and Infectious Disease Canada, the Canadian Society of Healthcare-Systems Pharmacy, and the Canadian Pharmacists Association. Those that develop undergraduate, postgraduate, and continuing professional development medical and pharmacy curricula, such as medical and pharmacy schools, should require learners to demonstrate culturally safe health care for Indigenous patients; using the example of vancomycin infusion reactions is a way to achieve this. Undergraduate and postgraduate health care education programs should audit teaching materials — including slides, teaching notes, and tutorials — for outdated terminology. Federal regulatory bodies that oversee pharmaceutical approvals should require changes in the wording of product monographs as needed. Entirely stopping the use of outdated, racist terminology is an important step on the reconciliation path to eliminate systemic, interpersonal and institutional racism within Canada’s health care systems. This should start immediately. Acknowledgements The authors are writing on behalf of the Canadian Paediatric Society’s Infectious Diseases and Immunization Committee (Fanella), the Canadian Society of Healthcare-Systems Pharmacy (Walus), and Indigenous Pharmacy Professionals of Canada (Swidrovich, Spina). Each author had their respective committee groups review the draft, contribute points, and provide final approval for submission. Footnotes Competing interests: Sergio Fanella reports travel support from the Canadian Paediatric Society; he sits on its Infectious Diseases and Immunization Committee. Ashley Walus reports serving as president of the Canadian Society of Healthcare-Systems Pharmacy and as a board member with the Manitoba branch of Lifesaving Society; both organizations provided travel support. No other competing interests were declared. This article has been peer reviewed. Contributors: Sergio Fanella conceived the work. All of the authors contributed to the design of the work, drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ References 1 ↵ Garrelts JC Peterie JD . Vancomycin and the “red man’s syndrome” . N Engl J Med 1985 ; 312 : 245 . Google Scholar OpenURL PubMed 2 ↵ Rothenberg HJ . Anaphylactoid reaction to vancomycin . J Am Med Assoc 1959 ; 171 : 1101 – 2 . Google Scholar OpenURL CrossRef PubMed Web of Science 3 ↵ Bruemmer R . McGill University to stop using the Redmen name for sports teams . Montreal Gazette ; 2019 Apr . 12 . Available: https://montrealgazette.com/news/local-news/mcgill-university-to-stop-using-the-redmen-name-for-sports-teams ( accessed 2023 Nov. 15 ). 4 ↵ Vancomycin dosing . Hamilton (ON) : Hamilton Health Sciences Centre ; 2016 . Available: https://idhandbook.hamiltonhealthsciences.ca/wp-content/uploads/2020/02/Aminoglycoside_Vancomycin_dosing_2016.pdf ( accessed 2026 Jan. 21 ). 5 Ontario Health at Home . Aminoglycoside/vancomycin referral: serum monitoring . Toronto : Ontario Ministry of Health ; 2021 . Available: https://www.ontariohealthathome.ca/blobohahprod4cd80afe1b/wp-content/uploads/2022/09/SE-Aminoglycoside-Vancomycin-Referral-Serum-Monitoring-Guide-EN-2.pdf ( accessed 2026 Jan. 21 ) 6 ISMP Canada Safety Bulletin (ISMP): Gaps in transition: management of intravenous vancomycin therapy in the home and community settings . Toronto : Institute for Safe Medication Practices Canada ; 2016 June 28 . Available: https://ismpcanada.ca/wp-content/uploads/ISMPCSB2016-04_Vancomycin.pdf ( accessed 2026 Jan. 21 ). 7 ↵ Neonatal Intensive Care Unit medication manual: vancomycin . London (ON) : Children’s Hospital London Health Sciences Centre . Available: https://www.lhsc.on.ca/nicu/vancomycin ( accessed 2026 Jan. 21 ). 8 ↵ Austin JP Empey A Foster BA . Position on terminology for vancomycin flushing reactions . Arlington (VA) : Infectious Diseases Society of America ; 2021 . Available: https://www.idsociety.org/globalassets/idsa/public-health/covid-19/vanc-flushing-syndrome-idsa-position-statement.pdf ( accessed 2023 Nov. 15 ). 9 ↵ Konold VJL Brothers AW Kronman M . Flushing an offensive term for vancomycin infusion reaction from the electronic medical record . Hosp Pediatr 2021 ; 11 : e317 – e321 . Google Scholar OpenURL CrossRef PubMed 10 ↵ Indigenous population continues to grow and is much younger than the non-Indigenous population, although the pace of growth has slowed . Ottawa : Statistics Canada ; 2022 Sept. 21 . Available: https://www150.statcan.gc.ca/n1/daily-quotidien/220921/dq220921a-eng.htm?indid=32990-1&indgeo=0 ( accessed 2023 Nov. 25 ). PDF Previous Next Back to top In This Issue CMAJ Vol. 198, Issue 28 10 Aug 2026 Table of Contents Index by author Article tools Respond to this article Print Download PDF Article Alerts Alerts for this Article User Name * Password * To sign up for email alerts or to access your current email alerts, enter your email address below: Email * Email Article Email This Article Thank you for your interest in spreading the word on CMAJ. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. 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