title: Chlorhexidine-induced anaphylaxis in surgical patients: a review of the literature.
abstract: BACKGROUND
  Chlorhexidine (CHL) has antiseptic and disinfectant properties used to prevent hospital-acquired infections. CHL-induced anaphylaxis is poorly reported in surgical literature despite government warnings and growing recognition. The aim of this review is to increase awareness of CHL-induced anaphylaxis in the surgical population.
  
  
  METHODS
  Literature review of Embase, Medline, PubMed and the Cochrane library using 'anaphylaxis (and) chlorhexidine' search terms.
  
  
  RESULTS
  Thirty-six articles were published on surgical patients suffering anaphylaxis to CHL. Within these, seven patients had two proven separate anaphylactic reactions and one had three separate proven anaphylactic reactions. The most commonly affected speciality was urology. The majority occurred during elective procedures. A history of atopy was surprisingly uncommon as was bronchospasm. Six patients required active chest compressions and 39.71% of patients had their surgical procedure abandoned. Unplanned intensive care admissions occurred in 27.94%.
  
  
  CONCLUSIONS
  In order to reduce abandoned procedures, unplanned intensive care unit admissions, morbidity and mortality associated with CHL-induced anaphylaxis we recommend the following: rationalization of CHL-containing products, greater vigilance regarding subtle symptoms of CHL allergy, appropriate investigation of these symptoms and a greater awareness of CHL-containing products. Lastly, we outline the appropriate investigations and highlight the need for meticulous documentation in those who are CHL allergic.
authors.affiliation: Department of General Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Sharp
authors.affiliation: Anaesthetic Allergy Service, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Green
authors.affiliation: Anaesthetic Allergy Service, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Rose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000139:chemically induced*; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D002648:Child; D002710:Chlorhexidine / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D003428:Cross Infection / Q000517:prevention & control*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D015995:Prevalence
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: anaphylaxis; chlorhexidine; surgery