Chlorhexidine allergy anaphylaxis

It is possible that the potential benefit of reducing the incidence of central venous sepsis by using chlorhexidine-coated catheters is outweighed by the risk of sudden and profound anaphylaxis. Certainly a high degree of suspicion of chlorhexidine allergy shonld be exercised and skin tests performed. 

Pham NH, Weiner JM, Reisner GS, Baldo BA. Anaphylaxis to chlorhexidine. Case report. Implication of immunoglobulin E antibodies and identification of an allergenic determinant. Clin Exp Allergy 2000 30(7) 1001-7. 

Ebo DG, Stevens WJ, Bridts CH, Matthieu L. Contact allergic dermatitis and hfe-threatemng anaphylaxis to chlorhexidine. J Allergy Chn Immunol 1998 101(1 Pt l) 128-9. 

Incidences of anaphylaxis to chlorhexidine are not necessarily readily found or widespread and, in fact, there are no reports of any cases from many countries. This may reflect the local absence of chlorhexidine preparations, failure to recognize and/or investigate reactions, the different concentrations used in antiseptics in different countries, or absence of sensitivity to the agent. The Danish Anaesthesia Allergy Centre, established in 1998 to investigate patients referred from all over Denmark, found 4 men of 21 patients with positive skin tests to various substances tested positive to chlorhexidine. Three cases of anaphylaxis to chlorhexidine were reported in Finland up to 1999, 11 cases were seen in Australia in the period 1985-1994 and 9 in Japan between 1967 and 1984. 

Immunologic Three cases of occupationally exposed workers with airway allergy to chlorhexidine were described [33 ]. A patient experienced anaphylaxis due to chlorhexidine delivered through multiple routes including a central venous catheter with chlorhexidine coating [34 ]. Three cases of anaphylaxis were caused by the insertion of central venous catheters impregnated with chlorhexidine [35 ]. Two further cases of anaphylaxis during urinary catheterisation with the aid of chlorhexidine gel lubrication were reported [36, 37 ]. 

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