Chlorhexidine skin symptoms and allergy in dialysis patients and nurses

Abstract

Chlorhexidine is a synthetic biguanide used as an antiseptic in hospital and household products. Chlorhexidine exposure has been implicated in various hypersensitivity reactions, including allergic contact dermatitis, fixed drug eruptions, occupational asthma, generalized urticaria and anaphylaxis. 1 Perioperative anaphylactic reactions to chlorhexidine have been reported since the 1990s and are typically caused by chlorhexidine-containing lubricants for in-dwelling urinary catheters, chlorhexidine-coated central venous catheters (CVCs) and topical chlorhexidine application. 2 Up to 9% of cases of IgE-mediated perioperative anaphylaxis in the UK have been attributable to chlorhexidine; a similar figure has been reported by a Danish study. 3,4 Since 1998, the US Food and Drug Administration has communicated the risk of serious hypersensitivity reactions to chlorhexidine. Notably, patients may exhibit early, unrecognized features of chlorhexidine sensitization prior to development of anaphylaxis. Guleri et al described three patients exhibiting pruritic rashes after topical chlorhexidine exposure who developed anaphylactic shock after insertion of a chlorhexidine-coated CVC. 5 In the dialysis setting, chlorhexidine is used for disinfection of skin and catheter exit sites for arteriovenous fistulas. A recent case series from a Canadian tertiary care centre of haemodialysis patients who developed life-threatening anaphylaxis induced by chlorhexidine-coated CVCs during renal transplantation suggested dialysis patients as an at-risk population. 6 Haemodialysis patients have previously reported rates of perceived chlorhexidine hypersensitivity from 12% to 23%. 7 Frequent chlorhexidine exposure could predispose both dialysis patients and staff to allergic sensitization.The purpose of our study was to assess the prevalence of chlorhexidine skin allergy symptoms and chlorhexidine sensitization in patients and staff in a dialysis setting. | ME THODSNurses and patients were recruited from haemodialysis units at the Toronto General Hospital from June 2018 through August 2018.Consenting participants were administered a questionnaire regarding chlorhexidine exposure history, allergic symptoms to chlorhexidine, and atopic history (Supplementary Material) and offered chlorhexidine skin prick testing (SPT). Serum samples were requested from participants with symptoms suggestive of chlorhexidine allergy or positive SPTs for measurement of serum specific IgE (sIgE) to chlorhexidine (ImmunoCAP, Phadia AB). Positive test criteria included SPT chlorhexidine weal diameter ≥3 mm with concordant positive control (histamine 1 mg/mL) and negative control (glycerinated phenol 0.9% saline) at 10 minutes, and/or sIgE >0.35 kUA/L. Reactions to chlorhexidine were classified as likely contact urticaria/pruritus, possible contact urticaria/pruritus or a rash/pruritus occurring more than 3 hours after chlorhexidine contact (Table 2 footnotes).Chlorhexidine skin allergy was defined as having a clinical history suggestive of chlorhexidine-associated ...

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

“…Most of the patients with chlorhexidineinduced anaphylaxis have had previous mild reactions to chlorhexidine exposure, however mild reactions to chlorhexidine are also observed in many patients without chlorhexidine allergy. 48 The history of exposure could be retrospectively identified from these patients. Therefore, opportunities taken to investigate exposure history for early identification of chlorhexidine-allergic patients may prevent more severe reactions in the future.…”

Developments allergy in 2019 through the eyes of Clinical and Experimental Allergy, Part II clinical allergy

“…Chan and colleagues published a paper highlighting the important issue of chlorhexidine allergy. 22 Around on-in-ten patients and nurses on a dialysis unit had cutaneous sensitization with a significant minority having clinical allergy. Reactions to contrast agents are a real concern.…”