title: Standardized testing with chlorhexidine in perioperative allergy--a large single-centre evaluation.
abstract: 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 IgE (Immunocap® ; Phadia AB, Sweden), histamine release test (HR) (RefLab ApS, Denmark), skin prick test (SPT) and intradermal test (IDT). Positivity criteria were as follows: specific IgE >0.35 kUA/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 IgE (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.
authors: National Allergy Research Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark; Allergy Clinic, Danish Anaesthesia Allergy Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
authors: M S
authors: MS
authors: Opstrup
authors: H-J
authors: HJ
authors: Malling
authors: M
authors: M
authors: Krøigaard
authors: H
authors: H
authors: Mosbech
authors: P S
authors: PS
authors: Skov
authors: L K
authors: LK
authors: Poulsen
authors: L H
authors: LH
authors: Garvey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D002710:Chlorhexidine / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007159:Immunologic Tests / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012680:Sensitivity and Specificity
chemical_list: D000891:Anti-Infective Agents, Local; D007073:Immunoglobulin E; D002710:Chlorhexidine
keywords: IgE; anaphylaxis; drug allergy; immunologic tests