Contact allergy to chlorhexidine in a tertiary dermatology clinic in Denmark

Opstrup, Morten Schjørring; Johansen, Jeanne Duus; Zachariae, Claus; Garvey, Lene Heise

doi:10.1111/cod.12487

Cited by 45 publications

(44 citation statements)

References 23 publications

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“…This polysensitization is not without any consequence since it constraints antiseptic use especially for their general use and for surgical site. In addition, these three components are also wellknown preservatives in drugs and cosmetics and thus limit their prescription …”

Section: Discussionmentioning

confidence: 99%

A child polysensitized to all constituents of Biseptine

et al. 2019

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Contact allergy to ultrasound gel is rare, and most of the cases were associated with propylene glycol, parabens, isothiazolinones, and methyldibromo glutaronitrile in Euxyl K 400. 3,4 Patch tests with sensitized patients' triethanolamine-containing preparations are frequently negative. Therefore, it is advisable to test the components of the ultrasound gel, including emulsifiers, to the extent possible, in patients with suspected ultrasound gel-related contact dermatitis. If no conclusive positive result is achieved, the remaining ingredients should be obtained from the manufacturer for full testing. The other ingredients were not tested, but these were not suspected to be contact allergens.To our knowledge, this is the first case of contact dermatitis due to triethanolamine contained in an ultrasound gel. We advocate labelling medical devices, including ultrasound gel, with their complete qualitative composition, as is the case for all cosmetic products. CONFLICT OF INTERESTSNone to declare. ORCID Filipa T. Almeidahttps://orcid.org/0000-0001-6561-5338A 6-year-old boy, with no personal or family history of atopy or allergy, developed an acute episode of ear eczema, with secondary spreading to the neck and chest. Based on the history obtained from his parents, we noted the application of several topical treatments,including Biseptine, to address a small posttraumatic wound of the ear. The boy was tested with the European baseline series adapted for children 3 (Chemotechnique Diagnostics, Vellinge, Sweden), with his hygiene and cosmetics products, and with all topical drugs applied to the wound, including Biseptine and its three components: chlorhexidine digluconate 0.5% aq., benzalkonium chloride 0.1% aq., and benzyl alcohol 10% softisan, provided by chemotechnique diagnostics.Readings were performed on day (D) 2 and D3 according to the ESCD guideline. 3 Strong positive reactions on D2 (++) and D3 (++) were seen for Biseptine and, notably, for all three of its constituents: CH++, BC++, and BA++ without any other positive test reactions (Figure 1). | DISCUSSIONContact allergy to topical antiseptics is mainly described in adults but has also been reported recently in children, highlighting the young age of patients, misdiagnosis, and/or delay in diagnosis. 1,2,4 In this recently reported series, chlorhexidine and benzalkonium chloride were the most commonly reported allergens in young patients. 2 A few children were positive to both CH and BC. We had not yet observed a child with polysensitization to all three constituents of Biseptine and, to our knowledge, this has never been reported. The origin of this intriguing early sensitization has been discussed previously and seems to be connected to antiseptic use (mainly Biseptine) during maternity care of the umbilical cord. 1,2 This polysensitization is not without any consequence since it constraints antiseptic use especially for their general use and for surgical site. In addition, these three components are also wellknown preservatives in drugs and cosmetics and...

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Section: Discussionmentioning

confidence: 99%

A child polysensitized to all constituents of Biseptine

et al. 2019

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“…Furthermore, 38 positive reactions in 3716 patients tested with chlorhexidine digluconate were observed, and it is therefore considered to be a relatively rare allergen (standardized prevalence 1.5%, 95%CI: 1.1-1.9%), although some reactions may have been missed. Indeed, Opstrup et al (38) recently investigated chlorhexidine contact allergy in Denmark, and detected a prevalence of 1.0%; they suggested that chlorhexidine diacetate should also be tested.…”

Section: The Allergensmentioning

confidence: 99%

Frequency and trends of contact allergy to and iatrogenic contact dermatitis caused by topical drugs over a 25-year period

Gilissen

Goossens

2016

Contact Dermatitis

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“…In Europe, one of the most widely employed antiseptics is chlorhexidine digluconate, both in aqueous and alcoholic solution . Allergic contact dermatitis (ACD) to chlorhexidine is fairly common in adults, with a prevalence of up to 1%, but it is quite rare in pediatric population . We report 4 cases of ACD to chlorhexidine in pediatric patients diagnosed in our department between May and November 2018.…”

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confidence: 92%

“…The different commercial formulations of this antiseptic must be taken into account, as some regularly used excipients, such as benzyl alcohol, which can also cause ACD . Furthermore, we must inform parents that chlorhexidine is not only present in antiseptic products but also as a component of cosmetics . Last but not least, it is imperative to rule out immediate hypersensitivity reactions, as even mild cases of ACD can indicate a potential risk of acute hypersensitivity reactions following successive exposures to chlorhexidine …”

mentioning

confidence: 99%

Allergic contact dermatitis to chlorhexidine in pediatric patients

Magdaleno‐Tapial

Martínez‐Doménech

Valenzuela‐Oñate

et al. 2019

Pediatric Dermatology

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Chlorhexidine is one of the most widely used antiseptics in our environment. Allergic contact dermatitis to chlorhexidine is common in adults, but is quite rare in the pediatric population. Its diagnosis is important because it can mimic other dermatoses common during childhood, and it can also lead to acute immediate hypersensitivity | 541 Pediatric Dermatology BRIEF REPORT undiagnosed. 1 Only 4 cases have been reported of ACD to chlorhexidine in pediatric patients without underlying AD. 3-5 Darrigade et al reported the largest case series of pediatric patients with ACD to chlorhexidine. Epicutaneous patch testing for chlorhexidine digluconate was positive in 7 of 14 patients tested, whereas 8 of them exhibited positivity to benzyl alcohol and positivity to both allergens in 4 cases. 1Our work showcases the role of chlorhexidine as a cause for ACD in the pediatric population, especially, but not exclusively, among patients with AD. It is worth noting that a history of surgery at an early age was identified in one patient suggesting the possibility that sensitization had occurred then. We emphasize the clinical utility of ROAT as a simple initial diagnostic approach during the initial evaluation of a patient presenting with symptoms suggestive of ACD to chlorhexidine. The different commercial formulations of this antiseptic must be taken into account, as some regularly used excipients, such as benzyl alcohol, which can also cause ACD. 1 Furthermore, we must inform parents that chlorhexidine is not only present in antiseptic products but also as a component of cosmetics. 2 Last but not least, it is imperative to rule out immediate hypersensitivity reactions, as even mild cases of ACD can indicate a potential risk of acute hypersensitivity reactions following successive exposures to chlorhexidine. 6

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Contact allergy to chlorhexidine in a tertiary dermatology clinic in Denmark

Cited by 45 publications

References 23 publications

A child polysensitized to all constituents of Biseptine

A child polysensitized to all constituents of Biseptine

Frequency and trends of contact allergy to and iatrogenic contact dermatitis caused by topical drugs over a 25-year period

Allergic contact dermatitis to chlorhexidine in pediatric patients

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