References

Bahal S, Sharma S, Garvey LH, Nagendran V Anaphylaxis after disinfection with 2% chlorhexidine wand applicator. BMJ Case Rep. 2017; 2017

Chan FL, Merchant AA, Breede N, Lipszyc JC, House R, Tarlo SM Chlorhexidine skin symptoms and allergy in dialysis patients and nurses. Clin Exp Allergy. 2019; 49:(8)

Cogné Y, Mouton-Faivre C, Cavasino T, Teychene AM, de Pontual L, Dewachter P Chlorhexidine-induced IgE-mediated allergy in a 6-year-old child. J Allergy Clin Immunol Pract. 2017; 5:(3)837-838

Anaesthesia, surgery and life-threatening allergic reactions. Report and findings of the Royal College of Anaesthetists' 6th National Audit Project. 2018. https://www.niaa.org.uk/NAP6Report (accessed 14 February 2020)

Doolan BT, Crilly HM Chlorhexidine wipes: time to stop and think about allergy. Anaesth Intensive Care. 2019; 47:(1)90-95 https://doi.org/10.1177/0310057X18811974

Egner W, Helbert M, Sargur R Chlorhexidine allergy in four specialist allergy centres in the United Kingdom, 2009-13: clinical features and diagnostic tests. Clin Exp Immunol. 2017; 188:(3)380-386 https://doi.org/10.1111/cei.12944

Laxenaire MC Epidemiology of anesthetic anaphylactoid reactions. Fourth multicenter survey (July 1994-December 1996). Ann Fr Anesth Reanim. 1999; 18:(7)796-809 https://doi.org/10.1016/S0750-7658(00)88460-9

Marty Cooney R, Manickam N, Becherer P The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients. Br J Nurs. 2020; 29:(2)S24-S26 https://doi.org/10.12968/bjon.2020.29.2.S24

Nakonechna A, Dore P, Dixon T Immediate hypersensitivity to chlorhexidine is increasingly recognised in the United Kingdom. Allergol Immunopathol (Madr). 2014; 42:(1)44-49 https://doi.org/10.1016/j.aller.2012.08.001

Nightingale SL Hypersensitivity to chlorhexidine-impregnated medical devices. JAMA. 1998; 279:(21) https://doi.org/10.1001/jama.279.21.1684-JFD80005-2-1

Opstrup MS, Jemec GBE, Garvey LH Chlorhexidine allergy: on the rise and often overlooked. Curr Allergy Asthma Rep. 2019; 19:(5) https://doi.org/10.1007/s11882-019-0858-2

Rose MA, Garcez T, Savic S, Garvey LH Chlorhexidine allergy in the perioperative setting: a narrative review. Br J Anaesth. 2019; 123:(1)e95-e103 https://doi.org/10.1016/j.bja.2019.01.033

Sharp G, Green S, Rose M Chlorhexidine-induced anaphylaxis in surgical patients: a review of the literature. ANZ J Surg. 2016; 86:(4)237-243 https://doi.org/10.1111/ans.13269

Totty J, Forsyth J, Mekako A, Chetter I Life-threatening intraoperative anaphylaxis as a result of chlorhexidine present in Instillagel. BMJ Case Rep. 2017; 2017

Incorporation of chlorhexidine in alcohol skin swabs is not without risks of allergic reactions including anaphylaxis

27 February 2020
Letter to the Editor
02 February 2020
Volume 29 · Issue 4

Dear Editor,

We read with interest the article by Marty Cooney et al (2020) that showed significantly reduced central line-associated bloodstream infections after changing to chlorhexidine gluconate/alcohol device swabs instead of alcohol-only swabs in the inpatient dialysis population. Although lowering infections in this patient population is extremely important, the introduction of additional antiseptic agents may increase the risk of adverse events, such as allergic reactions. Our centre has previously reported on the problem of chlorhexidine allergy in patients undergoing urological procedures (Nakonechna et al, 2014; Totty et al, 2017), and a similar trend among dialysis patients has also been reported (Bahal et al, 2017; Chan et al, 2019).

A glimpse of the scale of this problem can be seen in the retrospective survey report of current practice into investigations of perioperative anaphylaxis, with 13 centres (from UK, Europe, Australia, New Zealand and USA) reporting a total of 252 chlorhexidine-related cases of anaphylaxis (Rose et al, 2019), and the 6th National Audit Project of anaesthetic hypersensitivity reactions by the Royal College of Anaesthetists, UK, identified chlorhexidine as the third most common cause of perioperative anaphylaxis (overall 9%) (Cook and Harper, 2018).

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