Ramazzini; Blog on work and health by Annet Lenderink

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Allergic to chlorhexidine?

Chlorhexidine is an effective antimicrobial agent commonly used, but it has been widely reported to cause IgE-mediated allergic reactions (from urticaria and angioedema to anaphylaxis) among patients undergoing surgery/invasive procedures. Until now there were no reports of clinically confirmed occupational IgE-mediated chlorhexidine allergy, but researchers identified 4 cases of occupational IgE-mediated allergy to chlorhexidine were  in the UK. They suggest that chlorhexidine allergy be included in the differential diagnosis of HCWs presenting with work-related allergic symptoms.

IgE-mediated chlorhexidine allergy: a new occupational hazard?
Nagendran, V., Wicking, J., Ekbote, A., Onyekwe, T., Heise Garvey, L. Occupational Medicine 2009 59(4):270-272

Background: Chlorhexidine is an effective antimicrobial agent commonly used in UK hospitals, primarily for skin decontamination. Recent UK infection control guidelines recommend the use of 2% chlorhexidine solution in specific clinical settings, thus increasing chlorhexidine use by health care workers (HCWs). Chlorhexidine has been widely reported to cause IgE-mediated allergic reactions (from urticaria and angioedema to anaphylaxis) among patients undergoing surgery/invasive procedures. Despite its widespread use in health care settings, there are no reports of clinically confirmed occupational IgE-mediated chlorhexidine allergy.

Aims: To identify cases of chlorhexidine allergy among health care workers.

Methods: A questionnaire was distributed among HCWs in wards and operating theatres at a UK district general hospital to raise awareness of potential chlorhexidine allergy and to invite those with possible clinical allergy to come forward for further testing. Diagnosis was based on an appropriate clinical history with positive serum-specific IgE to chlorhexidine and/or positive skin prick testing.

Results: Four cases of occupational IgE-mediated allergy to chlorhexidine were identified.

Conclusions: Despite its excellent antimicrobial properties, chlorhexidine is an occupational allergen. We suggest that chlorhexidine allergy be included in the differential diagnosis of HCWs presenting with work-related allergic symptoms. Increased awareness and easier access to chlorhexidine-specific IgE serological testing should facilitate early diagnosis of affected HCWs, allowing appropriate avoidance measures to be instigated—thus reducing the risk of potentially severe allergic reactions in the future.

Filed under: Allergies, Chemical agents, New occupational risks,

14 Responses

  1. As a dentist in Michigan, I had been using Hibiclens (chlorhexidine) for hand washing for several years and Peridex (chlorhexidine) as an oral rinse also; until (in 2004, as I recall) I suffered an anaphylactoid reaction while getting my teeth cleaned by my dental hygienist: about 5 minutes after subgingival irrigation I began sneezing repeatedly, developed a rash on my chest, angioedema of lower lip and wheezing. I was treated with benadryl i.m. and solu-cortef I.V.; symptoms subsided after about an hour. Subsequent testing by my allergist confirmed chlorhexidine allergy. Needless to say, I now keep chlorhexidine products out of my office; there are good alternatives for office use for my patients. I also wear an allergy alert necklace due to the widespread use of chlorhexidine in hospitals and doctor offices. SMT

    • gene says:

      hello, i was given chlorhexidine diglutimate at the dentist’s three weeks ago and i still have a slight burning sensation,raw,sensitive tongue. have you heard of others with this type of allergic reaction? what would you advise me to do? thx

      • Annet says:

        It is not clear that this would be an irritative or an allergic reaction. I would advise you to go back to the dentist and ask them.

      • caren says:

        I am currently on chlorhexidine rinse and believe I am having a reaction to it.I was on it for four days and have burning on sides my tongue and underneath the tongue. i was then told to continue the rinse and they gave me 800mg of ibuprofen and magic mouth rinse. I have managed 2 more days and I am miserable. i talked to the pharmacist and they said to stop the chlorhexidine rinse that I am having a reaction to it. The dentist said they thought that I just bit my tongue when I was numb. Tmw is saturday I am going to get a hold of dentist again! Glad I saw this!

  2. Pam says:

    I am an IV nurse. I use chlorhexidine daily when I insert IV or PICC lines. I had surgery last month and the site was prepped with chlorhexidine and left on for 24 hours. I ended up having an allergic reaction and have been band from the stuff till I am allergy tested. For the past month at work I am not allowed in PT care areas.

    • Annet says:

      Thanks for your comment Pam. You must feel uncertain in your work situation now, I suppose. What allergic reaction did you have: skin – lung or both involved. I would very much like to know what allergy testing will show and whether your reaction is IgE mediated or not.

  3. Jeremy says:

    Is there an alternative to using chlorhexidine hand wash?

    As currenlty is causes me to break out in a rash on my hands and wrisits approx a day after I use…it gets very itchy.

  4. Robert says:

    Hi there. I was prescribed cetrimide solution (with chlorhexidine) for cleaning my wound after a circumcision. All was well for the first two days. After applying the solution on the third day I developed a severe reaction around my penis – characterized by severe swelling and small blisters around the area where i had applied the solution. This reaction was so painfull and lasted for almost 24hrs.

    • Claire says:

      How did you get rid of it? I just had a thyroid biopsy four days ago and Chlorheidine glutamate was used to clean the skin surface. The procedure went fine but I have the same reaction you speak of all over my neck where the pink solution was. I’ve been taking antihistamines but it’s not enough. I’m getting redder and more painful. Claire

  5. Kass Jones says:

    Hi,

    I am an intensive care nurse and have recently been diagnosed with a Chlorhexadine allergy following occipital nerve injections through wet chlorhexadine resulting in respiratory distress and anaphylaxis followed by subsequent positive allergy testing. My job is now at risk as I have to carry an epi-pen. I would really like to hear from anybody else suffering the same or anybody who can offer some advice to either myself or my bosses within the NHS. Many thanks.

  6. Russell says:

    iam Allergic to chlorhexidine wipes was in hospital 4 days every where they stuck me with a needle 2 weeks later i broke out with a itchy red hive on every injection spot

    • Karen says:

      I have confirmed occupational exposure anaphylaxis to chlorhexadine with respiratory arrest as an outcome.
      Allergy tests performed by a consultant anaesthetist have confirmed this.
      I’d like to hear from any medical professionals with work related allergy.

    • Russell says:

      it’s happen again i had surgery again even knowing my allergies to chlorhexidine it looks like they used it again.i see a law suit this time it’s caused me more discomfort that i wanted.looks like this Hospital doesn’t listen

  7. Russell says:

    it’s happen again i had surgery again even knowing my allergies to chlorhexidine it looks like they used it again.i see a law suit this time it’s caused me more discomfort that i wanted.looks like this Hospital doesn’t listen

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