Chlorhexidine Allergy: On the Rise and Often Overlooked
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Purpose of Review
In recent years, the risk of allergy to chlorhexidine is increasingly recognised. In this review, we discuss why the allergy is so easily overlooked and point out several preventative initiatives that can minimise the risk of both chlorhexidine sensitisation and allergy development and accidental re-exposure in patients with chlorhexidine allergy. Testing for chlorhexidine allergy is also discussed.
Numerous reports have been published from many different specialties. Symptoms range from mild skin symptoms to life-threatening anaphylaxis. Testing for chlorhexidine allergy is based on skin testing and in vitro testing. Recently, it was found that both skin prick testing and specific IgE have high sensitivities and specificities.
This review gives an overview of chlorhexidine allergy with a special focus on preventative initiatives and testing.
KeywordsChlorhexidine Chlorhexidine allergy Skin testing Specific IgE Perioperative allergy Allergy testing
There are no external sources of funding.
Compliance with Ethical Standards
Conflicts of Interest
GBE Jemec has received honoraria from AbbVie, Chemocentryx, Coloplast, Incyte, Inflarx, Novartis, Pierre Fabre and UCB for participation on advisory boards, and grants from Abbvie, Leo Pharma, Janssen-Cilag, Regeneron, Sanofi, Astra-Zeneca and Novartis for participation as an investigator, and received speaker honoraria from AbbVie, Boehringer-Ingelheim, Galderma and MSD. He has also received unrestricted departmental grants from Abbvie, Leo Pharma and Novartis. LHG is an adjudication committee member for Merck, New Jersey US and Novo Nordisk, Denmark. MSO has no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.The chemical structure of chlorhexidine. https://da.wikipedia.org/wiki/Fil:Chlorhexidine.png. Accessed 24 Feb 2019.
- 5.•• Opstrup MS, Poulsen LK, Malling HJ, Jensen BM, Garvey LH. Dynamics of plasma levels of specific IgE in chlorhexidine allergic patients with and without accidental re-exposure. Clin Exp Allergy. 2016;46:1090–8 Study showing the dynamics of plasma levels in chlorhexidine allergy. CrossRefGoogle Scholar
- 23.Opstrup MS, Garvey LH (2019) Chlorhexidine allergy: mild allergic reactions can precede anaphylaxis in the healthcare setting—a case report. Turk J Anaesthesiol Reanim; Accepted.Google Scholar
- 25.Dick AG, Dhinsa B, Walker RP, Singh S. Delayed allergic reaction to ChloraPrepTM in foot and ankle surgery. J Foot Ankle Surg. 2018;58:2018–20.Google Scholar
- 29.Totty J, Forsyth J, Mekako A, Chetter I. Life-threatening intraoperative anaphylaxis as a result of chlorhexidine present in Instillagel. BMJ Case Rep. 2017. https://doi.org/10.1136/bcr-2017-221443.
- 34.Kofod C, Eriksen S, Garvey LH. Anafylaktisk shock udløst af klorhexidinskylning hos tandlæge. Tandlægebladet. 2017;121:336–9.Google Scholar
- 36.Bahal S, Sharma S, Garvey LH, Nagendran V. Anaphylaxis after disinfection with 2% chlorhexidine wand applicator. BMJ Case Rep. 2017. https://doi.org/10.1136/bcr-2017-219794.
- 40.•• Opstrup MS, Malling H-J, Krøigaard M, Mosbech H, Skov PS, Poulsen LK, et al. Standardized testing with chlorhexidine in perioperative allergy—a large single-centre evaluation. Allergy. 2014;69:1390–6 A study investigating the value of the diagnostic tests in chlorhexidine allergy. CrossRefGoogle Scholar
- 41.•• Egner W, Helbert M, Sargur R, Swallow K, Harper N, Garcez T, et al. Chlorhexidine allergy in four specialist allergy centres in the United Kingdom, 2009–13: clinical features and diagnostic tests. Clin Exp Immunol. 2017;188:380–6 A study characterizing patients with chlorhexidine allergy and evaluating the diagnostic tests in the United Kingdom. CrossRefGoogle Scholar
- 43.Leysen J, De Witte L, Bridts CH, Ebo DG. Anaphylaxis during general anaesthesia : a 10-year survey 1 at the University Hospital of Antwerp. P Belg Roy Acad Med. 2013;2:88–100.Google Scholar
- 46.The Therapeutic Goods Administration safety update on the risk of anaphylaxis caused by chlorhexidine in central venous catheters. https://www.tga.gov.au/publication-issue/medicines-safety-update-volume-3-number-3-june-2012. Accessed 24 Feb 2019.
- 47.Warning from New Zealand. https://medsafe.govt.nz/profs/PUArticles/June2013Chlorhexidine.htm. Accessed 24 Feb 2019.
- 48.The Medicines and Healthcare products Regulatory Agency alert regarding the risk of anaphylactoid reactions caused by chlorhexidine in medical devices and medicinal products. https://www.gov.uk/drug-device-alerts/medical-device-alert-all-medical-devices-and-medicinal-products-containing-chlorhexidine-risk-of-anaphylactic-reaction-due-to-chlorhexidine-allergy. Accessed 24 Feb 2019.
- 49.The risk of chlorhexidine allergy evaluated by Health Canada. https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-topical-antiseptic-non-prescription-chlorhexidine-products-potential-risk.html. Accessed 24 Feb 2019.
- 50.FDA warning of serious allergic reactions caused by chlorhexidine. https://www.fda.gov/drugs/drugsafety/ucm530975.htm. Accessed 24 Feb 2019.
- 67.Geng V, Cobussen-Boekhorst H, FarrelI J, Gea-Sánchez M, Pearce I, Schwennesen T, et al. (2012) Catheterisation. Indwelling catheters in adults, urethral and suprapubic. Eur Assoc Urol Nurses;112.Google Scholar
- 68.European Association of Urology. https://uroweb.org/guideline/urological-infections/.
- 72.Chong HY, Lai NM, Apisarnthanarak A, Chaiyakunapruk N. Comparative efficacy of antimicrobial central venous catheters in reducing catheter-related bloodstream infections in adults: abridged cochrane systematic review and network meta-analysis. Clin Infect Dis. 2017;64(suppl_2):S131–40.CrossRefGoogle Scholar
- 73.Centers for Disease Control and Prevention recommendation of chlorhexidine impregnated central venous catheters when it is expected to be there for more than five days. https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html. Accessed 24 Feb 2019.
- 74.Guidelines on the Perioperative Management of Patients with Suspected or Proven Hypersensitivity to Chlorhexidine. Australian and New Zealand Anaesthetic Allergy Group (ANZAAG). http://www.anzca.edu.au/documents/ps60bp-2015-guidelines-on-the-perioperative-manage.pdf. Accessed 24 Feb 2019.