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Background: An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL‐GERDA) has collected many cases in the last few years. Objectives: To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB. Methods: We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB. Results: A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components. Conclusion: CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children. [ABSTRACT FROM AUTHOR]

Chlorhexidine (CHD) is commonly included in surgical antiseptics and can be associated with adverse reactions ranging from contact dermatitis to anaphylaxis. A 32-year-old female presented to the OR for facial fat grafting. Surgical sites were prepped with CHD gluconate or topical iodine. Donor and recipient sites were infiltrated with local anesthetic injection prior to fat harvest and facial injection. Eleven days later, she presented with new painful, pruritic rash over donor sites where CHD had been applied prior to local anesthetic infiltration. Treatment with topical clobetasol and prednisone taper resulted in complete symptom resolution. This patient's response most likely represented a delayed type IV, T-cell mediated hypersensitivity. CHD is a known trigger of allergic reactions. Infiltration of local anesthetic may introduce skin prep into the subcutaneous tissue akin to intradermal testing. For those with delayed cutaneous reactions, steroids may provide symptomatic relief. [ABSTRACT FROM AUTHOR]

Background: Annually, almost 2 billion peripheral intravenous cannulas (PIVCs) are placed worldwide. In response to concerns of infectious complications, chlorhexidine is increasingly utilised for maintenance decontamination of PIVC injection ports. Concomitantly, the allergenic potential of chlorhexidine exposures has been highlighted by several case reports, implicating it as a trigger when used for this seemingly innocuous process. Given how widespread this application is, elucidating potential chlorhexidine exposure is needed to gauge its risks and benefits. Objective: To examine and quantify if chlorhexidine is entrained when used for PIVC injection port cleaning. Methods: Twenty benchtop PIVC set‐ups were cleaned with 2% chlorhexidine and 70% alcohol wipes, following three different pragmatic protocols. Each set‐up was injected with 10 ml ultrapure water, and samples tested by liquid chromatography‐electrospray tandem mass spectrometry for entrained chlorhexidine. Results: Chlorhexidine was detected in every sample. Mean concentrations and standard deviations from each protocol were 41.47 ppb (4.08), 54.76 ppb (17.46), and 65.84 ppb (7.01). One‐way ANOVA indicated a statistical difference between at least two groups (df = 2, F = 24.11, p <.00001), with Tukey's testing verifying significantly different mean concentrations between all groups (p <.01). Conclusions: Using 2% chlorhexidine and 70% alcohol swabs to decontaminate PIVC injection ports resulted in consistent entrainment of chlorhexidine, with varying amounts correlated to how it was applied. These results validate case reports attributing anaphylactic/allergic reactions to suspected intravenous chlorhexidine entrainment and should factor into future risk–benefit assessments for its use in PIVC maintenance antisepsis policies and protocols. [ABSTRACT FROM AUTHOR]

Included subjects comprise all patients aged <=16 years with a clinical history of ACD from chlorhexidine and a positive patch test to this compound that were attended at the Department of Dermatology of Cruces University Hospital between January 2013 and November 2022. 2010; 27 (5): 485 - 7. https://doi.org/10.1111/j.1525-1470.2010.01257.x 8 Evangelista V, Vincenzi C, Bruni F, Piraccini BM, Neri I. Contact dermatitis apparently triggered by meningococcal and polyvalent vaccines: a case of allergic contact dermatitis due to chlorhexidine. [Extracted from the article]

Contact allergy to skin disinfectants is not often recognized in children. We report the cases of six children (1–16.5 years old) with allergic contact dermatitis to ingredients commonly contained in commercial antiseptic and cosmetic products. Patch test responses to chlorhexidine, benzyl alcohol, and benzalkonium chloride varied from one child to another one, but most children were sensitized to at least two components. In several of the cases, exposure had initially occurred in the neonatal period, but diagnosis occurred only after multiple reactions of increasing severity. [ABSTRACT FROM AUTHOR]

Chlorhexidine is a synthetic antiseptic of the biguanide family, with a broad spectrum of antibacterial action. Chlorhexidine allergy was confirmed with at least two confirmatory tests: positive prick or intradermal test and positive chlorhexidine serum-specific IgE (ImmunoCap ThermoFischer Scientific, Uppsala, Sweden: positive chlorhexidine threshold was defined as equal or above 0.1 kUA/L). Chlorhexidine allergy diagnosis was confirmed by prick testing and positive chlorhexidine-specific serum IgE. [Extracted from the article]

(D) Pustular patch-test reactions (++) on day (D)3 to (benzyl alcohol-containing) Amycor cream "as is" (Merck Serono SAS, Lyon, France), to (benzyl alcohol-containing) Terbinafine cream "as is", and to benzyl alcohol 10% sof. Keywords: acute generalized exanthematous pustulosis; AGEP; allergic contact dermatitis; benzyl alcohol; CAS no. 100-51-6; case report EN acute generalized exanthematous pustulosis AGEP allergic contact dermatitis benzyl alcohol CAS no. 100-51-6 case report 100 102 3 06/14/22 20220701 NES 220701 Benzyl alcohol is a preservative often used in topical drugs and cosmetics and occasionally responsible for allergic contact dermatitis (ACD).1 We report a peculiar case of ACD from benzyl alcohol mimicking acute generalized exanthematous pustulosis (AGEP), which highlights that common topical drug excipients may occasionally be important culprit sensitizers. [Extracted from the article]

Background: Contact dermatitis from topical antiseptic use has been reported mostly in adults, but rare cases of chlorhexidine contact dermatitis have also been described in young children. Objective: To evaluate contact allergic dermatitis to antiseptics in young children. Methods: The children mostly referred for a misdiagnose (cellulitis) were patch tested with a selection of the European baseline series, an antiseptics series and the personal topical products used. Results: Fourteen children (8 boys, 6 girls) received a diagnosis of contact dermatitis to antiseptics between May 2010 and December 2017. The mean age at diagnosis was 38 months (8 months to 8 years); three children only had a personal history of atopy. Chlorhexidine gluconate was positive in seven cases, and benzalkonium chloride in eight cases, and in four cases, both allergens were positive. Conclusion: These small case series confirm that both chlorhexidine and benzalkonium chloride are implicated in contact dermatitis from antiseptic use in the paediatric population. We emphasize the initial misdiagnose of these patients, the very young age of the children and the allergenic potential of common antiseptics in non‐atopic children. We hypothesize that the systematic use of antiseptics for umbilical cord care could be responsible for the sensitization in newborns. [ABSTRACT FROM AUTHOR]

Objective: Local anaesthetics are very commonly used drugs in dentistry, and people who undergo procedures with local anaesthetics often refer adverse reactions that are not of allergic origin. Considering that in dentistry contact with allergens is very frequent, it is essential to assess the real incidence of allergy to local anaesthetics. Subjects and Methods: We evaluated a group of 159 patients in whom adverse reaction occurred after procedures with local anaesthetics. Results: The reactions between allergy to local anaesthetic (immediate and delayed) and certain symptoms presented by patients were investigated. Allergy to latex and chlorexidine were investigated in all patients. Only one patient, who previously presented a constant erythema at the wrist after procedure with local anaesthetics, was positive to Mepivacaine patch test. Two patients were positive to latex and one to chlorexidine. Conclusions: The main finding of this study was that a reaction registered in the medical history and reported by a patient is rarely allergic but the use of vasoconstrictors or emotional factors may account for it. However, a complete allergological investigation is necessary for a correct diagnosis and future management. [ABSTRACT FROM AUTHOR]

These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed. These guidelines also address the roles of graded challenge and in vitro testing. The implications of anaphylaxis associated with neuromuscular blocking agents, beta-lactam antibiotics, local anaesthetic agents and chlorhexidine are discussed. Evidence for the recommendations is derived from literature searches using the words skin test, allergy, anaphylaxis, anaesthesia, and each of the individual agents listed in these guidelines. The individual articles were then reviewed for suitability for inclusion in these guidelines. Where evidence was not strong, as is the situation for many perioperative agents, expert consensus from the ANZAAG working party was used. These guidelines are intended for use by specialists involved in the investigation of perioperative allergy. They have been approved following peer review by members of ANZAAG and are available on the ANZAAG website: http://www.anzaag.com/anaphylaxis-management/testing-guidelines.pdf. [ABSTRACT FROM AUTHOR]

Chlorhexidine can cause severe immediate-type allergic reactions such as urticaria, anaphylactic shock or, even, cardiac arrest. We report the case of a patient who developed perioperative anaphylactic shock caused by chlorhexidine 1 year after a postoperative urticarial reaction, which was assumed not to be significant at the time. This case highlights the importance of identifying mild allergy symptoms after exposure to chlorhexidine at the pre-anaesthetic assessment to prevent more severe allergic reactions in future. [ABSTRACT FROM AUTHOR]

Background Perioperative allergic reactions to chlorhexidine are often severe and easily overlooked. Although rare, the prevalence remains unknown. Correct diagnosis is crucial, but no validated provocation model exists, and other diagnostic tests have never been evaluated. The aims were to estimate (i) the prevalence of chlorhexidine allergy in perioperative allergy and (ii) the specificity and sensitivity for diagnostic tests for chlorhexidine allergy. Methods We included all patients investigated for suspected perioperative allergic reactions in the Danish Anaesthesia Allergy Centre during 2004-2012. The following tests were performed: specific Ig E ( Immunocap®; Phadia AB, Sweden), histamine release test ( HR) ( RefLab Ap S, Denmark), skin prick test ( SPT) and intradermal test ( IDT). Positivity criteria were as follows: specific Ig E >0.35 k UA/l; HR class 1-12; SPT mean wheal diameter ≥3 mm; IDT mean wheal diameter ≥ twice the diameter of negative control. Chlorhexidine allergy was post hoc defined as a relevant clinical reaction to chlorhexidine combined with two or more positive tests. Based on this definition, sensitivity and specificity were estimated for each test. Results In total, 22 of 228 patients (9.6%) met the definition of allergy to chlorhexidine. Estimated sensitivity and specificity were as follows: specific Ig E (sensitivity 100% and specificity 97%), HR (sensitivity 55% and specificity 99%), SPT (sensitivity 95% and specificity 97%) and IDT (sensitivity 68% and specificity 100%). Conclusions In patients investigated for suspected perioperative allergic reactions, 9.6% were diagnosed with allergy to chlorhexidine. Using our definition of chlorhexidine allergy, the highest combined estimated sensitivity and specificity was found for specific IgE and SPT. [ABSTRACT FROM AUTHOR]

Chlorhexidine is a commonly used antiseptic agent in the health-care setting. Although exposure to chlorhexidine is very common, allergic contact dermatitis ( ACD) is rarely reported. We report a case series of ACD to chlorhexidine in health-care workers and discuss our rates of allergy to chlorhexidine, from patch-testing performed at the Skin and Cancer Foundation, Melbourne, Australia. Of 7890 patients patch-tested, 840 patients were tested to 0.5% chlorhexidine diacetate with 28 (3%) positive reactions, 13 (2%) of which relevant to their presenting dermatitis. Altogether 1565 patients were tested to 0.5% chlorhexidine digluconate, with 47 (3%) positive reactions, 16 (1%) of which were relevant. We estimate our rate of relevant chlorhexidine ACD from our total clinic patients, non-occupational and occupational, to be at least 19/7890 (0.24%). Our rate of relevant chlorhexidine ACD in health-care workers is 10/541 (2%). Interestingly, our rates of chlorhexidine allergy are slightly higher than documented elsewhere. This raises the possibility that chlorhexidine is underestimated as an allergen worldwide, and should be tested for in health-care workers where there is a history of exposure. [ABSTRACT FROM AUTHOR]

This article presents a study regarding the chlorhexidine-based antiseptic solution and alcohol-based povidine-iodine for central venous catheter care. Of 538 catheters randomized, 89.4 percent produced evaluable culture results. Compared with povidone-iodine, the chlorhexidine-based solution was linked with a 50 percent decrease in the incidence of catheter colonization. The findings show that chlorhexidine-based solutions should be considered as a povidine-iodine formulations to prevent catheter-related infection.

The article discusses about Allergic contact dermatitis caused by chlorhexidine and para-amino compounds. According to the article, a child had surgical operations after being born with tetralogy of Fallot. It was said that the boy underwent surgeries and after 3 days following the last surgery, skin rashes appeared and was treated with chlorhexidine but days after, the rash continued. It was learned through patch testing that the boy had allergies to antiseptics.

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. Recent Findings: 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. Summary: This review gives an overview of chlorhexidine allergy with a special focus on preventative initiatives and testing. [ABSTRACT FROM AUTHOR]

The author discusses the research "Standardized testing with chlorhexidine in perioperative allergy ? A large single centre evaluation" by M.S. Opstrup and colleagues, present within the issue. Topics discussed include analysis of patients with perioperative anaphylaxis by the Danish Anaesthesia Allergy Center (DAAC), the drugs and substances responsible for perioperative anaphylaxis, and the difficulty iin confirming allergy in the perioperative setting without a provocation test.

The article presents a case study of a 68-year old non-atopic man who was referred from Department of Urology due to suspected allergic skin reaction. It states that the patient had been diagnosed with prostate cancer, and 2 days later developed severe swelling and redness of scrotal and penile skin. It notes that patch testing was performed using extended European baseline series. It mentions that he was informed about contact allergy to cetrimide.