title: Immediate hypersensitivity to chlorhexidine is increasingly recognised in the United Kingdom.
abstract: BACKGROUND
  Chlorhexidine is widely used as an antiseptic agent. It is a potentially allergenic substance that can cause severe hypersensitivity reactions.
  
  
  OBJECTIVE
  We describe six patients who had anaphylactic reactions attributed to chlorhexidine during surgery. These patients were exposed to chlorhexidine in gels, swabs and catheters.
  
  
  METHODS
  Six patients from three UK centres with clinical history suggestive of anaphylaxis during surgery are reported. Detailed history, review of case notes, determination of chlorhexidine specific IgE, mast cell tryptase and skin tests were performed.
  
  
  RESULTS
  On detailed assessment five of six patients demonstrated a previous history of reactions on re-exposure to chlorhexidine. All six patients had elevated specific IgE to chlorhexidine. Skin prick test with chlorhexidine was performed in four of the six patients and was found to be positive.
  
  
  CONCLUSIONS
  Immediate hypersensitivity to chlorhexidine appears to be common but underreported in the UK. We recommend that centres investigating patients with reactions during anaesthesia and surgery should routinely include testing for chlorhexidine allergy.
authors.affiliation: Department of Immunology, Hull Royal Infirmary, Hull and East Yorkshire NHS Hospital Trust, UK.
authors.forename: A
authors.initials: A
authors.lastname: Nakonechna
authors.affiliation: Department of Immunology, Hull Royal Infirmary, Hull and East Yorkshire NHS Hospital Trust, UK.
authors.forename: P
authors.initials: P
authors.lastname: Dore
authors.affiliation: Allergy Clinic, Liverpool Royal and Broadgreen University NHS Trust Hospital, UK.
authors.forename: T
authors.initials: T
authors.lastname: Dixon
authors.affiliation: Department of Immunology, Frimley Park Hospital NHS Foundation Trust, UK.
authors.forename: S
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Immunology, Frimley Park Hospital NHS Foundation Trust, UK.
authors.forename: S
authors.initials: S
authors.lastname: Deacock
authors.affiliation: Department of Immunology, Hull Royal Infirmary, Hull and East Yorkshire NHS Hospital Trust, UK.
authors.forename: S
authors.initials: S
authors.lastname: Holding
authors.affiliation: Department of Immunology, Hull Royal Infirmary, Hull and East Yorkshire NHS Hospital Trust, UK. Electronic address: abuzakm@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Abuzakouk
mesh_terms: D000368:Aged; D000485:Allergens / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D013504:Cardiovascular Surgical Procedures; D002710:Chlorhexidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D003558:Cystoscopy; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012882:Skin Tests; D006113:United Kingdom; D013521:Urologic Surgical Procedures, Male
chemical_list: D000485:Allergens; D000891:Anti-Infective Agents, Local; D007073:Immunoglobulin E; D002710:Chlorhexidine