Chlorhexidine: a hidden life-threatening allergen

Junka

et al. 2021

IJMS

Local administration of antiseptics is required to prevent and fight against biofilm-based infections of chronic wounds. One of the methods used for delivering antiseptics to infected wounds is the application of dressings chemisorbed with antimicrobials. Dressings made of bacterial cellulose (BC) display several features, making them suitable for such a purpose. This work aimed to compare the activity of commonly used antiseptic molecules: octenidine, polyhexanide, povidone-iodine, chlorhexidine, ethacridine lactate, and hypochlorous solutions and to evaluate their usefulness as active substances of BC dressings against 48 bacterial strains (8 species) and 6 yeast strains (1 species). A silver dressing was applied as a control material of proven antimicrobial activity. The methodology applied included the assessment of minimal inhibitory concentrations (MIC) and minimal biofilm eradication concentration (MBEC), the modified disc-diffusion method, and the modified antibiofilm dressing activity measurement (A.D.A.M.) method. While in 96-well plate-based methods (MIC and MBEC assessment), the highest antimicrobial activity was recorded for chlorhexidine, in the modified disc-diffusion method and in the modified A.D.A.M test, povidone-iodine performed the best. In an in vitro setting simulating chronic wound conditions, BC dressings chemisorbed with polyhexanide, octenidine, or povidone-iodine displayed a similar or even higher antibiofilm activity than the control dressing containing silver molecules. If translated into clinical conditions, the obtained results suggest high applicability of BC dressings chemisorbed with antiseptics to eradicate biofilm from chronic wounds.

Section: Introductionmentioning

confidence: 99%

In Vitro Efficacy of Bacterial Cellulose Dressings Chemisorbed with Antiseptics against Biofilm Formed by Pathogens Isolated from Chronic Wounds

Junka

et al. 2021

IJMS

“…The following in vitro tests are available to assess the diagnosis of chlorhexidine allergy: detection of specific IgE, histamine release test, and BATs. Although many patients have undergone quantification of specific IgE, few patients with chlorhexidine-induced anaphylaxis have undergone BATs [ 1 ]. We performed BATs in addition to specific IgE in our cases, with positive results in both.…”

Section: Discussionmentioning

confidence: 99%

“…Chlorhexidine is an antiseptic with a broad spectrum of activity and persistent effects on the skin. Since the widespread use of chlorhexidine, many cases of anaphylaxis have been reported [ 1 ]. The risk of chlorhexidine allergy has increasingly been recognized in recent years [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative chlorhexidine-induced anaphylaxis suggesting an immunoglobulin-E-dependent mechanism indicated by basophil activation tests: two case reports

et al. 2022

Background Although chlorhexidine allergy has been shown to be mediated by immunoglobulin (Ig) E, few reports investigated the mechanism of chlorhexidine-induced anaphylaxis using basophil activation tests (BATs). Case presentation A 79-year-old man underwent cholecystectomy under general anesthesia. Anaphylaxis was diagnosed based on the clinical symptoms and high serum tryptase and histamine levels. Skin tests showed positive results only for chlorhexidine. Subsequently, BATs demonstrated that the causative agent was likely chlorhexidine. The inhibitory effect of wortmannin, an inhibitor of phosphoinositide 3-kinase, on basophil activation suggested an IgE-dependent mechanism underlying chlorhexidine-induced anaphylaxis. An 89-year-old man underwent inguinal hernioplasty under general anesthesia. Anaphylaxis was diagnosed based on the clinical symptoms and high serum tryptase and histamine levels. Skin tests and BATs with wortmannin were performed, showing similar results to case 1. Conclusions BATs suggested an IgE-dependent mechanism for chlorhexidine-induced anaphylaxis and might be useful for investigating the mechanisms underlying drug-induced anaphylaxis.

“…Chlorhexidine allergy has recently been increasingly reported particularly in the perioperative and medical procedural settings. [9][10][11][12] The prevalence of perioperative allergic reactions was 9-10% in the United Kingdom, Denmark, and Belgium. [13][14][15] A recent survey from 13 centers reported 252 cases of anaphylaxis to chlorhexidine, and it was within the top four most commonly diagnosed causes of perioperative anaphylaxis along with neuromuscular blocking agents, antibiotics, and latex.…”

Section: Epidemiologymentioning

confidence: 99%

<p>Chlorhexidine Allergy: Current Challenges and Future Prospects</p>

Chiewchalermsri¹,

Sompornrattanaphan²,

Wongsa³

et al. 2020

JAA

Chlorhexidine is a synthetic bisbiguanide antiseptic and was introduced in healthcare use in 1954. Allergy to chlorhexidine has been increasingly reported particularly in the perioperative and medical procedural settings. The hypersensitivity reactions range from mild cutaneous reactions to anaphylaxis or death. There are many products and medical devices containing chlorhexidine that sometimes lack standardized labeling. With the various routes of chlorhexidine exposure, accidental or recurrent reactions in chlorhexidine-allergic patients have been reported. Therefore, we aim to review the most recent evidence in clinical manifestations, diagnostic methods, management, and preventive measures with a focus on the unique features of chlorhexidine allergy.