A Case of Anaphylaxis to Chlorhexidine during Digital Rectal Examination

Abstract

Chlorhexidine is widely used as an antiseptic and disinfectant in medical and non-medical environments. Although the sensitization rate seems to be low, its ubiquitous use raises the possibility of sensitization in many patients and medical care workers. We describe a patient with anaphylaxis during digital rectal examination with chlorhexidine jelly. Urticaria, angioedema, dyspnea, and hypotension developed within a few minutes of the rectal examination. The patient fully recovered after treatment with epinephrine and corticosteroids. Skin tests for chlorhexidine were undertaken 5 weeks later, showing positive prick and intradermal skin tests. Within 30 min of the skin test, the patient complained of febrile sensation, chest tightness, angioedema, and urticaria on the face and trunk. An enzyme allergosorbent test for latex was negative. We present this case to alert clinicians about hypersensitivity to chlorhexidine that could potentially be life-threatening. We suggest that chlorhexidine should be recognized as a causative agent of anaphylaxis during procedural interventions.

Chlorhexidine Anaphylaxis Masquerading as Septic Shock

“…This increase in chlorhexidine exposure has led to potential allergic sensitization of a majority of our patients, causing a full spectrum of adverse reactions ranging from contact dermatitis and generalized urticaria to anaphylactic shock [16] . Although there have been several reports in recent years about these adverse reactions to chlorhexidine, the majority of these were isolated case reports on HCW or on patients admitted for elective procedures [1,2,[7][8][9][10][11][12][13][14]16] . To our knowledge, this is the first report on chlorhexidine anaphylactic shock masquerading as septic shock from necrotising fasciitis.…”

“…Anaphylactic shock due to chlorhexidine has been reported after exposure to chlorhexidine via several routes such as direct contact with the skin or mucous membranes from chlorhexidine gargle, skin antisepsis lotion, lubricants or chlorhexidine-coated vascular and urinary catheters [1,2,[7][8][9][10][11][12][13][14]16] . In 2008, Bae et al [8] reported chlorhexidine anaphylaxis after digital rectal examination using chlorhexidine as a local rectal disinfectant; it was initially contributed to a latex allergy.…”

“…It is used most commonly for skin decontamination during hand-hygiene practice, shampooing or body/oral wash prior to surgery, skin antisepsis prior to venepuncture or insertion of vascular catheters, as a component of lubricant jelly or topical cream for local disinfectants and, occasionally, as a coating on vascular or urinary catheters [1,2,[7][8][9][10][11][12][13][14]16] . This increase in chlorhexidine exposure has led to potential allergic sensitization of a majority of our patients, causing a full spectrum of adverse reactions ranging from contact dermatitis and generalized urticaria to anaphylactic shock [16] .…”

“…In recent years, adverse reactions to chlorhexidine have been reported, ranging from allergic contact dermatitis, photosensitivity, fixed drug eruptions, urticaria and anaphylactic shock [1,2,[7][8][9][10][11][12][13][14] . Most have been isolated case reports and the adverse reactions occurred in patients who presented for elective procedures.…”

Prevention and Treatment of Virulent Bacterial Biofilms with an Enzymatic Nitric Oxide-Releasing Dressing

“…Contemporary therapies, including topically or systemically administered anti-infective agents such as chlorhexidine, povidone-iodine, silver-coated antimicrobial dressings, and antibiotics, are limited in their efficacy and necessitate a new paradigm for treating biofilms (2,3,8,46,48). Pseudomonas aeruginosa and multidrug-resistant organisms (MDROs) such as Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) represent a serious problem in hospitals due to nosocomial transmission and the difficulty in treating these infections with contemporary therapies (1,19,35).…”