Anaphylactic reactions to chlorhexidine are rare but are being reported increasingly in association with a variety of products.
Methods:
We report three cases of anaphylaxis to chlorhexidine in patients presenting for cardiac surgery.
Results:
In each case, anaphylaxis was precipitated by the insertion of a central venous catheter impregnated with chlorhexidine acetate. Subsequent investigations confirmed chlorhexidine as the causal agent.
Conclusion:
Extensive use of chlorhexidine to reduce hospital-acquired infections has the potential to sensitize a small proportion of patients, leading to life-threatening anaphylaxis on subsequent exposure.
Get full access to this article
View all access options for this article.
References
1.
O'GradyNP, AlexanderM, DellingerEPet al.Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol, 2002; 23:759–769.
2.
DarouicheRO, WallMJJr, ItaniKMet al.Chlorhexidine-alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med, 2010; 362:18–26.
3.
GuleriA, HartleyM. Throwing caution to the winds? Three cases of anaphylaxis to chlorhexidine coated central venous catheters from a regional cardiac centre in north-west England. Abstract presented at the 19th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), May 2009; abstract no. 0391. Published in an electronic supplement to Clinical Microbiology and Infectionwww.blackwellpublishing.com/eccmid19/abstract.asp?id=74050. 2011 January 3.
4.
GuleriA, KumarA, HartleyM, RobertsD. Are we throwing caution to the winds? 3 cases of anaphylaxis to chlorhexidine coated central venous catheters at Lancashire Cardiac Centre. J Hosp Infect, 2010; 76:S8.
5.
GarveyLH. Anaphylaxis to chlorhexidine. New Horizons, 2006; 2:1–5.
6.
OdaT, HamasakiJ, KandaN, MikamiK. Anaphylactic shock induced by an antiseptic-coated central venous catheter. Anesthesiology, 1997; 87:1242–1244.
7.
TerazawaE, ShimonakaH, NagaseKet al.Severe anaphylactic reaction due to chlorhexidine-impregnated central venous catheter. Anesthesiology, 1998; 89:1296–1298.
8.
GarveyLH, Roed-PetersenJ, HusumB. Anaphylactic reactions in anaesthetized patients: Four cases of chlorhexidine allergy. Acta Anaesthesiol Scand, 2001; 45:1290–1294.
9.
StephensR, MythenM, KallisPet al.Two episodes of life-threatening anaphylaxis in the same patient to a chlorhexidine–sulphadiazine-coated central venous catheter. Br J Anaesth, 2001; 87:306–308.
10.
KlugerM. Anaphylaxis to chlorhexidine-impregnated central venous catheter. Anaesth Intensive Care, 2003; 31:697–698.
OkanoM, NomuraM, HataSet al.Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol, 1989; 125:50–52.
13.
ThongCL, LambrosM, StewartMG, KamPC. An unexpected cause of an acute hypersensitivity reaction during recovery from anaesthesia. Anaesth Intensive Care, 2005; 33:521–524.
14.
KrautheimAB, JermannTHM, BircherAJ. Chlorhexidine anaphylaxis: case report and review of the literature. Con Derm, 2004; 50:113–116.
15.
BaeYJ, ParkCS, LeeJKet al.A case of anaphylaxis to chlorhexidine during digital rectal examination. J Korean Med Sci, 2008; 23:526–528.
16.
SnellmanE, RantanenT. Severe anaphylaxis after a chlorhexidine bath. J Am Acad Dermatol, 1999; 40:771–772.
17.
EboDG, BridtsCH, StevensWJ. Anaphylaxis to an urethral lubricant: Chlorhexidine as the “hidden” allergen. Acta Clin Belg, 2004; 59:358–360.
18.
ParkesAW, HarperN, HerwadkarA, PumphreyR. Anaphylaxis to the chlorhexidine component of instillagel: A case series. Br J Anaesth, 2009; 102:65–68.
19.
EboDG, StevensWJ, BridtsCH, MatthieuL. Contact allergic dermatitis and life-threatening anaphylaxis to chlorhexidine. J Allergy Clin Immunol, 1998; 101:128–129.
20.
StablesGI, TurnerWH, PrescottS, WilkinsonSM. Generalized urticaria after skin cleansing and urethral instillation with chlorhexidine-containing products. Br J Urol, 1998; 82:756–757.
LauermaAI. Simultaneous immediate and delayed hypersensitivity to chlorhexidine digluconate. Contact Dermatitis, 2001; 44:59.
23.
LiebermanP, KempSF, OppenheimerJet al.The diagnosis and management of anaphylaxis: An updated practice parameter. J Allergy Clin Immunol, 2005; 115,3 Suppl 2:S523–S583.
24.
GilbertRE, HardenM. Effectiveness of impregnated central venous catheters for catheter related blood stream infection: A systematic review. Curr Opin Infect Dis, 2008; 21:235–245.
