title: IgE-mediated allergy to chlorhexidine.
abstract: BACKGROUND
  Investigations at the Danish Anesthesia Allergy Centre have included testing for allergy to chlorhexidine since 1999.
  
  
  OBJECTIVE
  To investigate whether measurement of IgE and histamine release confirm an IgE-mediated mechanism for chlorhexidine allergy.
  
  
  METHODS
  Twenty-two patients with clinical history suggestive of chlorhexidine allergy were included. Skin tests with chlorhexidine and tryptase measurements were performed during initial investigations. Sera were analyzed retrospectively for IgE and histamine release (passive sensitization) to chlorhexidine.
  
  
  RESULTS
  Twelve patients were skin test positive and 10 were skin test negative. Of the skin test-positive patients, 11 of 12 had IgE to chlorhexidine and 7 of 11 had a positive histamine release test. None of the skin test-negative patients had specific IgE or positive histamine release to chlorhexidine. Skin test-positive patients had higher median age (64 vs 49 y) and were mainly male (11/12 vs 6/10). In both groups, 8 patients had hypotension, but bronchospasm mainly appeared in skin test-negative patients (1/12 vs 6/10). Reactions occurred more often during urologic surgery in skin test-positive patients (5/12 vs 0/10). Baseline tryptase was higher in skin test-positive patients (median, 11.5 vs 3.7 microg/L), and 6 of 7 patients had elevated IgE to chlorhexidine in serum at the time of reaction.
  
  
  CONCLUSIONS
  This study confirms that chlorhexidine allergy is IgE-mediated and that measurement of specific IgE and histamine release are good adjuncts to skin testing in patients with clinical history suggesting chlorhexidine allergy.
  
  
  CONCLUSIONS
  IgE and histamine release can be used to support the diagnosis of allergy to chlorhexidine.
authors.affiliation: Danish Anaesthesia Allergy Centre, Copenhagen University Hospital, Rigshospitalet, Department of Anaesthesia 4231, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. lene@heisegarvey.dk
authors.forename: Lene Heise
authors.initials: LH
authors.lastname: Garvey
authors.forename: Mogens
authors.initials: M
authors.lastname: Krøigaard
authors.forename: Lars K
authors.initials: LK
authors.lastname: Poulsen
authors.forename: Per Stahl
authors.initials: PS
authors.lastname: Skov
authors.forename: Holger
authors.initials: H
authors.lastname: Mosbech
authors.forename: Lennart
authors.initials: L
authors.lastname: Venemalm
authors.forename: Fredrik
authors.initials: F
authors.lastname: Degerbeck
authors.forename: Bent
authors.initials: B
authors.lastname: Husum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002710:Chlorhexidine / Q000009:adverse effects* / Q000276:immunology; D004202:Disinfectants / Q000009:adverse effects* / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D005260:Female; D006636:Histamine Release; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D007022:Hypotension / Q000209:etiology; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012882:Skin Tests; D053802:Tryptases / Q000097:blood; D013520:Urologic Surgical Procedures
chemical_list: D004202:Disinfectants; D007073:Immunoglobulin E; D053802:Tryptases; D002710:Chlorhexidine