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Chlorhexidine Tomaz Garcez Consultant Immunology

Chlorhexidine Tomaz Garcez Consultant Immunology. What we already know (1). Chlorhexidine is widely used in healthcare and the community (see appendix in report) A “hidden allergen” responsible for a significant number of cases of perioperative anaphylaxis Geographical variation

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Chlorhexidine Tomaz Garcez Consultant Immunology

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  1. ChlorhexidineTomazGarcezConsultant Immunology

  2. What we already know (1) • Chlorhexidine is widely used in healthcare and the community (see appendix in report) • A “hidden allergen” responsible for a significant number of cases of perioperative anaphylaxis • Geographical variation • Under-recognition • Differential practice / use of decontamination / testing for allergy • Highly effective antiseptic

  3. What we already know (2) • Uses include: • Skin decontamination • Lubricating gels • Coated catheters (CVC) • Dental • Commonly there are features of a prior reaction in those subsequently confirmed with allergy • Investigation for allergy not standardised (timing or tests) • Positive tests to other potential culprits reported

  4. Key Findings (1) • 3rd of the “big four” – 18 cases (9%) • 16 males • 6 urology surgery; 3 cardiac; 3 orthopaedics • 0.78 events per 100,000 exposures (possible overestimate) • 1 fatal case • Not investigated by specific IgE to chlorhexidine

  5. None where only reported exposure was skin preparation for cannulation

  6. Clinical features

  7. Key Findings (2) • Often not suspected (only in 28% of cases) by anaesthetist • 3 potentially avoidable cases • 1 reported prior chlorhexidine allergy • 1 reported prior perioperative allergy that was not investigated • 1 NAP6 confirmed chlorhexidine allergy case experienced subsequent anaphylaxis to chlorhexidine in 2nd procedure • Chlorhexidine coated central lines not always removed (2 of 6 CVC related cases)

  8. Key Findings (3) 16 patients had dynamic / raised tryptase Testing for chlorhexidine was frequently omitted in allergy clinics Testing does not always follow recommendations

  9. Only 7 cases had more than one test as is recommended • In 3 cases more than one trigger identified on testing

  10. Key Recommendations • National: • Prominent labelling (MHRA & manufacturers) • Institutional: • Alternatives should be available • All cases should be tested for chlorhexidine with at least 2 modalities of test; and all potential culprits should be tested • Individual: • Improved awareness of chlorhexidine and allergy history taking • Chlorhexidine coated CVCs should be removed when anaphylaxis occurs following insertion

  11. Thank you

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