SELECTED ARTICLES FROM THE RECENT LITERATURE 2007

August 20, 2007

IgE mediated reactions to chlorhexidine

Summary
Background - Chlorhexidine (C-hex) is a topical disinfectant used extensively including a common use as a skin prep during surgery. It is also commonly used in urologic procedures. Therefore, allergy to C-hex has been suspected as a possible cause of peri-operative anaphylaxis .

Findings - Garvey et al of the Danish Anesthesia Allergy Centre in Copenhagen investigated 22 patients with clinical histories suggestive of an allergic reaction to C-hex in the surgical/perioperative period. Skin tests with C-hex were positive in 12 individuals, 11 of whom had in vitro evidence of serum IgE anti C-hex antibodies. In 7 of these 12 patients, there was evidence of C-hex induced in vitro histamine release from basophils. These in vitro findings were not present in the 10 C-hex skin test negative patients. Hypotension had occurred during the suspected C-hex reaction in both those with positive and negative skin tests to C-hex. However, of interest, bronchospasm had occurred in the reactions in 6 of 10 C-hex skin test negative, but only one of 12 skin test positive patients. Conversely, the clinical reactions occurred during urologic procedures in 5 of 12 skin test positive but in none of the skin test negative.

Reference
J Allergy Clin Immunol 2007;120:409-15

Editor's Comments
These interesting findings certainly suggest that adverse reactions to C-hex, some IgE-mediated, have to be added to the list of reactions suspected as cause of peri-operative anaphylaxis. It is unclear why bronchospasm had occurred in the C-hex skin test negative but not in the skin test positive patients. Perhaps another agent used in the peri-operative period caused the bronchospasm.

 

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