Anaphylaxis to benzalkonium chloride-coated central venous catheter

Shih, Chih-Kai; Huang, Shu-Hung; Tsai, Chih-Cheng; Chu, Koung‐Shing; Wu, Sheng‐Hua

doi:10.1016/j.jclinane.2009.09.017

Cited by 6 publications

(4 citation statements)

References 14 publications

(17 reference statements)

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“…In another case, an infant experienced severe esophageal injury after ingesting a 10% BAC solution administered by her mother to treat the infant’s cough 5 . Ulcerative contact dermatitis and anaphylaxis to BAC‐coated catheters have also been reported 6,7 …”

Section: Discussionmentioning

confidence: 99%

Benzalkonium chloride induced corrosive balanoposthitis in a man requiring clean intermittent catheterization

et al. 2021

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Introduction Men who require intermittent catheterization may be susceptible to balanoposthitis. Benzalkonium chloride is commonly used to disinfect reusable catheters, but the concentration of this solution is critical. Case presentation A 40‐year‐old man presented with fever, pus around the glans and foreskin, and difficult catheterization. On physical examination, his urethral meatus was too narrow to insert a catheter. Suprapubic catheterization and 2 weeks of intravenous and topical treatment cured the ulcer of the glans. However, after restarting catheterization, the ulcer of the glans relapsed, and the patient’s urethral meatus was completely closed. Circumcision and incision of the meatus were performed, and antibiotics were administered. Unexpectedly, restarting catheterization caused recurrent balanoposthitis. Close inquiry revealed that the patient was using a 10% benzalkonium chloride soaking solution for a reusable catheter, which was a toxic concentration. Conclusion The disinfectant concentration should be confirmed when refractory balanoposthitis is encountered in patients who require catheterization.

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Section: Discussionmentioning

confidence: 99%

Benzalkonium chloride induced corrosive balanoposthitis in a man requiring clean intermittent catheterization

et al. 2021

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“…17 Anaphylaxis was reported following administration of xylometazoline nasal drops containing BAC, 17 following administration of nebulised salbutamol containing BAC 18 and after insertion of a BAC-coated central venous cannula. 19 There has since been a call to remove BAC from all nebulised solutions. 20 Dextran-20 is used as an excipient used in haemocoagulase agkistrodon, a medication regularly used in China for patients undergoing abdominal surgery with a history of haemophilia and thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

Preuss

Goddard

Clarke

et al. 2020

Anaesth Intensive Care

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Investigation of intraoperative anaphylaxis includes the exclusion of potential trigger agents the individual was exposed to within a plausible interval preceding the reaction. Occasionally, none of these agents will test positive. In this situation it is important to consider that excipients may be responsible for anaphylaxis, that the dilutions prepared to test the medication may not contain an appropriate concentration of the excipient to induce a positive skin reaction, or if an alternative formulation of the medication is tested, it may not contain the culprit excipient. This case describes a patient, who previously experienced an anaphylactic reaction to Betadine® (Sanofi-Aventis Australia Pty Ltd, North Ryde BC, NSW) experiencing anaphylaxis in the recovery period after general anaesthesia where Betadine was avoided. The recently administered therapeutics were excluded by skin testing, however further investigation determined that a povidone-containing formulation of paracetamol had been administered. Skin testing with povidone-containing paracetamol resulted in a positive reaction in the patient, but not in a volunteer control. Pharmaceutical excipients are added to medications to increase absorption, shelf-life and efficacy. Different brands of the same drug may contain different excipients. When testing for anaphylaxis with such compounds one must be sure the dilution is appropriate for both the parent compound and the excipient to ensure the accuracy of skin-prick and intradermal testing. This case demonstrates the potential for excipients to cause severe allergy and the importance of detailed history pertaining to previous allergic episodes as even the most unlikely of medications can potentially result in anaphylaxis due to excipients.

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“…BAC is notorious for unfavorable effects like contact sensitivity, bronchoconstriction,[ 5 ] anaphylaxis and angioneurotic edema. [ 6 ] Literature search revealed instances where BAC used in eye drops,[ 4 ] nebulizer solutions[ 7 ] and central venous catheters[ 7 ] have triggered anaphylaxis in susceptible individuals. Anaphylaxis initiated by BAC in nasal drops has been once reported previously during a mucosal detumescence (diagnostic) procedure.…”

Section: Discussionmentioning

confidence: 99%

Xylometazoline nasal drops induced anaphylaxis: An atypical perioperative complication

Haldar

Bajwa

Kaur

2017

J Anaesthesiol Clin Pharmacol

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Xylometazoline nasal drops used for nasal decongestion can have side-effect in the form of palpitation, hypertension, headache, and tremors. Anaphylaxis to xylometazoline nasal drops is a relatively unrecognized complication. We encountered a patient posted for tonsillectomy who developed serious anaphylaxis upon administration of a commercially available preparation of xylometazoline nasal drops and required aggressive management for stabilization. Further evaluation and literature search indicated toward the preservative (benzylalkonium chloride) as the cause of this adverse event.

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Anaphylaxis to benzalkonium chloride-coated central venous catheter

Cited by 6 publications

References 14 publications

Benzalkonium chloride induced corrosive balanoposthitis in a man requiring clean intermittent catheterization

Benzalkonium chloride induced corrosive balanoposthitis in a man requiring clean intermittent catheterization

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

Xylometazoline nasal drops induced anaphylaxis: An atypical perioperative complication

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