A 14 year old boy was admitted to the intensive care unit with suspected staphylococcus toxic shock syndrome. He presented with multiple skin abscesses, fever, headache, macular rash and low blood pressure at 102/49. He was treated with intravenous cefazolin and clindamycin. Five minutes after starting his clindamycin infusion, he complained of throat tightening and dyspnea. Physical examination revealed angioedema, conjunctival hyperemia, generalized hives and wheezing. Saturation decreased to 88%. He was immediately treated with epinephrine, diphenhydramine, salbutamol, hydrocortisone, and symptoms were rapidly controlled except for remaining low diastolic blood pressure. Clindamycin was suspected and discontinued. However, he continued to be febrile and the addition of clindamycin to his penicillin treatment was suggested to inhibit the production of exotoxin associated with toxic shock syndrome, as currently recommended. Considering that infectious episodes can simulate drug allergic reactions, that clindamycin allergy is rare, and that he had never received clindamycin in the past to explain sensitization, we decided to perform a graded drug provocation test. After infusion of 380 mg, he developed throat tightness, hand pruritus, dyspnea, wheezing, and his oxygen saturation went down to 84%. Symptoms were rapidly controlled with epinephrine. The patient was subsequently treated with vancomycin and as his clinical evolution was favorable, there was no indication to proceed with clindamycin desensitization. At follow-up 2 months later, skin prick test (SPT) and intradermal tests (IDT) were performed, and both were positive. Undiluted SPT with clindamycin (150 mg/ml)) was positive with an 8 mm wheal diameter and a negative saline control. IDTs were positive at dilutions of 10
−5 and 10
−3, with respective wheals of 10 mm and 12 mm with surrounding erythema compared to a negative IDT saline control. These dilutions were reported as non-irritating [
7]. Because it was the first time that he received clindamycin antibiotherapy, we asked the parents to look for other sources of exposure to clindamycin. After verification, the mother reported the use of clindamycin gel for acne on one or two occasions in the previous year. Otherwise, this patient was known for previous asthma and peanut allergy during infancy, both of which completely resolved. He also presented a history of AD since childhood, for which he continues to apply daily moisturizing cream, tacrolimus 0.1% ointment and desoximetasone cream to maintain the control of his AD.