title: Chlorhexidine allergy in four specialist allergy centres in the United Kingdom, 2009-13: clinical features and diagnostic tests.
abstract: We describe an observational survey of diagnostic pathways in 104 patients attending four specialist allergy clinics in the United Kingdom following perioperative hypersensitivity reactions to chlorhexidine reactions. The majority were life-threatening. Men undergoing urological or cardiothoracic surgery predominated. Skin prick testing and specific immunoglobulin (sIg)E testing were the most common tests used for diagnosis. Fifty-three per cent of diagnoses were made on the basis of a single positive test. Where multiple tests were performed the sensitivity of intradermal, basophil activation and skin prick testing was 68% (50-86%), 50% (10-90%) and 35% (17-55%), respectively. Seven per cent were negative on screening tests initially, and 12 cases were only positive for a single test despite multiple testing. Intradermal tests appeared most sensitive in this context. Additional sensitization to other substances used perioperatively, particularly neuromuscular blocking agents (NMBA), was found in 28 patients, emphasizing the need to test for possible allergy to all drugs to which the patient was exposed even where chlorhexidine is positive.
authors.affiliation: Clinical Immunology and Allergy Unit, Northern General Hospital, Sheffield, UK.
authors.forename: W
authors.identifier: 0000-0002-2654-9881
authors.initials: W
authors.lastname: Egner
authors.affiliation: Department of Allergy and Immunology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Helbert
authors.affiliation: Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sargur
authors.affiliation: Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: K
authors.initials: K
authors.lastname: Swallow
authors.affiliation: Department of Anaesthesia, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Harper
authors.affiliation: Department of Immunology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Garcez
authors.affiliation: Department of Immunology, Leeds Teaching Hospitals, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: Savic
authors.affiliation: Department of Anaesthetics, Leeds Teaching Hospitals, Leeds, UK.
authors.forename: L
authors.initials: L
authors.lastname: Savic
authors.affiliation: Department of Immunology, Southampton General Hospital, Southampton, UK.
authors.forename: E
authors.initials: E
authors.lastname: Eren
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis*; D002710:Chlorhexidine / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D012882:Skin Tests; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007073:Immunoglobulin E; D002710:Chlorhexidine
keywords: anaesthesia; anaphylaxis; chlorhexidine allergy; skin tests; specific IgE