Allergic urticaria: A case report of rare skin allergy with a common mouthwash

Abstract

Chlorhexidine is a widely used antiseptic and disinfectant in medical and non-medical environments. Compared to its ubiquitous use, allergic contact dermatitis from chlorhexidine has rarely been reported and so its sensitization rate seems to be low. Chlorhexidine has been used for more than 50 years but it was only in the last two decades, that reports of immediate- type reactions to chlorhexidine were seen. Reactions ranging from localized urticaria to anaphylactic shock and hypersensitivity reactions, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions, and photosensitivity reactions, began to appear more frequently. However the prevalence of contact urticaria and anaphylaxis due to chlorhexidine remains to be unknown. In this case report we have reported a case of urticaria due to oral use of chlorhexidine. The adverse reaction was confirmed by a skin prick test.

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] .…”

“…activity against Gram-positive bacteria, somewhat less activity against Gram-negative bacteria and fungi and minimal activity against mycobacteria [1,2] . Its usage has increased in recent years with intensive campaigns and infection control guidelines to combat hospital-acquired infections [3,4] .…”

“…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.…”