Delayed and immediate‐type hypersensitivity to chlorhexidine

Bergqvist-Karlsson, A

doi:10.1111/j.1600-0536.1988.tb02745.x

Cited by 80 publications

(33 citation statements)

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“…The cutaneous application of chlorhexidine has been followed by anaphylactoid and immediate or delayed skin reactions of eczematous or urticarial type, but has never been implicated as a cause of bullous lesions. 5,6 Mupirocin is usually well tolerated, but can occasionally induce burn-type lesions, rash, edema, and exudation. 7 In 1987, Daly reported a case of vesicular dermatitis following the topical administration of mupirocin in a patient suffering from a chronic stasis dermatitis.…”

Section: Discussionmentioning

confidence: 99%

“…This may result in a delay of the implementation of contact isolation precautions for MRSA as recommended by the Centers for Disease Control and Prevention. 6 The mother had had prior contact with the healthcare system due to prenatal care. More detailed questioning after the result of the blood culture was known also revealed that she had been caring for an individual with a chronic wound infection.…”

Section: Discussionmentioning

confidence: 99%

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Toxic Epidermal Necrolysis After Topical Intranasal Application of Mupirocin

Praz¹,

Torrenté²,

Zender³

et al. 2003

Infect. Control Hosp. Epidemiol.

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We describe a case of toxic epidermal necrolysis after intranasal application of mupirocin in a 76-year-old woman. The drug was given for eradication of methicillin-resistant Staphylococcus aureus (Infect Control Hosp Epidemiol 2003;24:459-460).Toxic epidermal necrolysis (TEN) is characterized by an erythemato-bullous skin eruption followed by epidermal necrolysis with skin scaling and mucosal involvement. The general consequences are extended burns. Mortality is approximately 20% to 30%, increasing with age and the extent of the lesions. 12 The most severe complications are sepsis and ocular involvement. The mechanisms responsible for the accelerated apoptosis of the keratinocytes remain unclear, but, besides multiple factors, drugs are clearly implicated. Many agents are deemed responsible for TEN. Among the most frequently cited are nonsteroidal anti-inflammatory drugs, sulfonamides, and anticonvulsants.3 Until now, TEN occurring after topical intranasal applications of mupirocin has never been described. CASE REPORTA 76-year-old woman with a tracheostomy after operation for an oropharyngeal carcinoma was admitted to our hospital for ventilatory weaning. Her usual medications were prednisone, ipratropium bromide, salbutamol, citalopram, hydrochlorothiazide, lisinopril, aspirin, and acetaminophen. She had been treated with the same medication regimen for several weeks before entering our hospital. She was allergic to penicillin and had asthma.Eighteen days later, sputum cultures yielded methicillin-resistant Staphylococcus aureus. The patient was isolated, bathed with chlorhexidine once a day, and treated with mupirocin intranasally twice a day. Two days later, a skin eruption of a maculo-erythematous type appeared around the nares, evolving rapidly into bullae and extending to the cheeks and neck, accompanied by a fever (temperature, 38°C and higher). The patient had been given two baths with chlorhexidine and four intranasal applications of mupirocin before the onset of the rash. Despite the discontinuation of intranasal mupirocin and the chlorhexidine baths, the skin lesions progressed in the form of large bullae involving the face and upper trunk, covering approximately 20% of the body surface area. A positive Nikolsky sign confirmed the clinical diagnosis of TEN. With the consent of the patient, considering her dismal oncologic prognosis and bedridden state, no life support was started. Five days after the eruption of the dermal lesions, the patient died of sepsis. DISCUSSIONIn this patient, TEN appeared after the application of mupirocin for eradication of methicillin-resistant S. aureus. It is highly probable that mupirocin, introduced 2 days before the appearance of the skin disease, was the cause because, except for chlorhexidine skin antisepsis given at the same time, no other medication had been introduced during the 4 preceding weeks. In particular, acetaminophen, often cited as a cause of TEN, 4 had been given for many weeks for the patient's chronic pain due to the oropharyngeal carcino...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Toxic Epidermal Necrolysis After Topical Intranasal Application of Mupirocin

Praz¹,

Torrenté²,

Zender³

et al. 2003

Infect. Control Hosp. Epidemiol.

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show abstract

“…Therefore, an intact skin barrier cannot be assumed. Open application tests with chlorhexidine to undamaged skin in patients with immediate-type hyperreactivity have been reported in three of the reviewed articles [6,10,11]. Two showed a wheal after 1 h. The third was positive, but this might have been due to the mistaken application of chlorhexidine to a slightly exanthematous skin site [11].…”

Section: Discussionmentioning

confidence: 99%

Immunological Contact Urticaria and Anaphylaxis to Chlorhexidine: Overview

2002

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For more than 50 years chlorhexidine has been widely used as a medical disinfectant, as an additive for wound dressings or as a preservative in many cosmetic products, personal care products and drugs. In the last two decades, reports of immediate-type reactions to chlorhexidine reaching from localized urticaria to anaphylactic shock began to appear more frequently. However, the prevalence of contact urticaria and anaphylaxis due to chlorhexidine remains unknown. In this article, we reviewed the literature using PubMed, entering queries for ‘chlorhexidine anaphylaxis’, ‘chlorhexidine contact urticaria’ and ‘chlorhexidine allergy’. In total we reviewed 66 case reports. Twenty reactions occurred when chlorhexidine was applied to damaged skin surfaces, 27 patients showed an immediate-type reaction when chlorhexidine was applied to mucous membranes. Sixteen reports, all but one of them from Japan, concerned anaphylactic reactions after introduction of a chlorhexidine-coated central venous catheter. Slight damage to the epidermal barrier or application to mucous membranes seems to enhance the immediate reaction to chlorhexidine. Life-threatening shocks may be provoked even by application of chlorhexidine at its lowest bactericidal concentration. The diagnosis was confirmed by prick testing, intradermal testing or scratch testing. In 16 case reports, more than one severe immediate-type reaction occurred, because chlorhexidine had not been identified as the cause of one or more earlier episodes, suggesting that severe anaphylactic reactions to chlorhexidine are still not well recognized.

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“…29 Chlorhexidine has also been associated with potential anaphylactic reactions. [30][31][32] Studies with radiolabeled chlorhexidine mouthrinse have shown its ability to penetrate the intact mucosal barrier of the oral cavity or intestinal tract. 33,34 Ohtoshi et al 35 reported more than 30 cases of anaphylactic shock after the topical application of chlorhexidine.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

IJPSR

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ABSTRACT:To evaluate the antimicrobial activity of Octenidine (OCT) 0.1%, Chlorhexidine (CHX) 0.2% against bacterial strains of Enterococcus faecalis and Staphylococcus aureus. The strains were inoculated in 7ml of brain heart infusion broth and diluted to reach the concentration equivalent (0.5 McFarland standard). 1ml of organism suspension was contacted with 1ml of each mouthwash and was removed at time interval of 3,5 and 10 minute and plated on Brain Heart Infusion agar. After 72 hours of incubation, colony counts were measured using stereomicroscope. Kruskal Wallis test was conducted on mean number of CFU. Post-hoc tests were conducted by using the Mann Whitney U test and Duncan's-test of multiple comparisons. The results showed that OCT 0.1% was found to be the most effective in substantially reducing total bacterial counts after 3, 5 and 10 min time interval. OCT 0.1% was found to be the most effective in substantially reducing total bacterial counts.

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Delayed and immediate‐type hypersensitivity to chlorhexidine

Abstract: A case with both contact urticaria and delayed-type contact allergy to chlorhexidine is presented. A review of the literature on hypersensitivity reactions of delayed and immediate type to this compound is given.

Cited by 80 publications

References 14 publications

Toxic Epidermal Necrolysis After Topical Intranasal Application of Mupirocin

Toxic Epidermal Necrolysis After Topical Intranasal Application of Mupirocin

Immunological Contact Urticaria and Anaphylaxis to Chlorhexidine: Overview

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