1
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Leventis M, Deliberador T, Alshehri F, Alghamdi H. Topical oxygen therapy as a novel strategy to promote wound healing and control the bacteria in implantology, oral surgery and periodontology: A review. Saudi Dent J 2024; 36:841-854. [PMID: 38883907 PMCID: PMC11178966 DOI: 10.1016/j.sdentj.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
Globally, oral infections and inflammatory lesions persist as substantial public health concerns, necessitating the introduction of novel oral treatment protocols. Oral diseases are linked to various causative factors, with dental plaque/biofilm resulting from inadequate hygiene practices playing a predominant role. The strategic implementation of novel topical therapies holds promise for effectively controlling the biofilms, addressing oral infections and promoting enhanced oral wound healing. This review aims to providing a comprehensive overview of the available evidence pertaining to the potential efficacy of topical oxygen and lactoferrin-releasing biomaterials, exemplified by the blue®m formula, as novel oral care interventions within the scope of contemporary implantology, oral surgery and periodontology.
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Affiliation(s)
- Minas Leventis
- Department of Oral and Maxillofacial Surgery, Dental School, National and Kapodistrian University of Athens, Greece
| | - Tatiana Deliberador
- Department of Periodontics, Saveetha Dental College, Chennai, India, and Latin American Institute of Dental Research and Education - ILAPEO, Curitiba/PR, Brazil
| | - Fahad Alshehri
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Hamdan Alghamdi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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2
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Figuero E, Serrano J, Arweiler NB, Auschill TM, Gürkan A, Emingil G. Supra and subgingival application of antiseptics or antibiotics during periodontal therapy. Periodontol 2000 2023. [PMID: 37766668 DOI: 10.1111/prd.12511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/17/2023] [Accepted: 06/22/2023] [Indexed: 09/29/2023]
Abstract
Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.
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Affiliation(s)
- Elena Figuero
- Department of Dental Clinical Specialties, Etiology and Therapy of Periodontal and Peri-implant Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
- Etiology and Therapy of Periodontal and Peri-implant Research Group, University Complutense of Madrid, Madrid, Spain
| | - Jorge Serrano
- Etiology and Therapy of Periodontal and Peri-implant Research Group, University Complutense of Madrid, Madrid, Spain
| | - Nicole Birgit Arweiler
- Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Marburg, Germany
| | - Thorsten Mathias Auschill
- Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Marburg, Germany
| | - Ali Gürkan
- Department of Peridontology, Ege University School of Dentistry, Bornova, Turkey
| | - Gülnur Emingil
- Department of Peridontology, Ege University School of Dentistry, Bornova, Turkey
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3
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Amaliya A, Ramadhanti R, Hadikrishna I, Maulina T. The Effectiveness of 0.2% Chlorhexidine Gel on Early Wound Healing after Tooth Extraction: A Randomized Controlled Trial. Eur J Dent 2022; 16:688-694. [PMID: 35016228 PMCID: PMC9507567 DOI: 10.1055/s-0041-1739544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective
This study aimed to evaluate the effect of 0.2% chlorhexidine (CHX) gel on wound healing after tooth extraction.
Materials and Methods
A single blind, randomized controlled trial was performed recruiting 32 participants who underwent dental extractions. Patients were randomly allocated for CHX group or placebo group. The primary outcomes were wound closure measured with calipers and healings were assessed by Landry et al index after 7 days of topical application of allocated gels on extraction sites.
Results
The wound closures were greater in CHX group compared with placebo group and healing scores were correlated with the use of CHX gel (
p
-value < 0.05).
Conclusion
In a population of healthy nonsmoker adults, application of 0.2% CHX gel twice a day for 7 days after tooth extraction has a beneficial effect on wound healing.
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Affiliation(s)
- Amaliya Amaliya
- Department of Periodontology, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Rika Ramadhanti
- Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Indra Hadikrishna
- Department of Oral Surgery, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Tantry Maulina
- Department of Oral Surgery, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
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4
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Review of allergic reactions from use of chlorhexidine on medical products in clinical settings over 40 years: Risks and mitigations. Infect Control Hosp Epidemiol 2021; 43:775-789. [PMID: 34078513 DOI: 10.1017/ice.2021.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chlorhexidine is an antimicrobial agent widely used for infection prevention in medical settings. Nevertheless, allergic reactions ranging from mild to severe have been reported following its use. In this review, we analyzed all case reports published between the introduction of chlorhexidine and the end of 2019 for allergic responses associated with the use of medical devices and or other medical products containing chlorhexidine (CHX) to ascertain the prevalence of severe CHX allergic reactions and what practices might best mitigate those risks.In total, 77 publications containing 124 reported cases of allergic reactions were grouped into 3 product categories, catheters, semisolids, and fluid products. The country, type of reaction, route of sensitization, allergy confirmation, and intervention or mitigation was extracted for each case. Overall, 30 cases were associated with catheters, 46 cases were associated with semisolid products, and 48 cases were associated with the use of other medical products. Severe cases were managed with intravenous fluids, steroids, and epinephrine (adrenaline). None of the reported cases were fatal. The allergy risks can be mitigated by better warning and training clinicians and by recording and screening patient histories for CHX presensitization from prior exposure. For patients undergoing pre-use blood tests, IgE antibody screens can also be performed. Finally, as a precaution in the event a rare severe allergic reaction occurs, procedure carts and rooms can be prestocked with injectable epinephrine and other rapidly acting anti-inflammatory medications.
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5
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[Tolerance and effectiveness of an alcoholic solution of 2% chlorhexidine in patients with a long-term central venous route.]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2021; 66:10-15. [PMID: 33962724 DOI: 10.1016/s0038-0814(21)00092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Alcoholic chlorhexidine 2 % is recommended for the prevention of catheter infections. A retrospective study was conducted in a nutritional assistance unit in a cohort of patients with a long-term central venous route. The tolerance (number of skin reactions) and efficacy (number of infections/days of catheters) of this antiseptic used in repeated care in these patients were described.
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6
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Contact Allergy to Topical Drugs. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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Lahouel I, Ben Salah N, Ben Fadhel N, Belhadjali H, Aouam K, Youssef M, Zili J. Contact urticaria caused by chlorhexidine in hydroalcoholic gel. Contact Dermatitis 2020; 84:338-339. [PMID: 33131054 DOI: 10.1111/cod.13735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ines Lahouel
- Dermatology Department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Nesrine Ben Salah
- Dermatology Department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Najah Ben Fadhel
- Pharmacology Department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Hichem Belhadjali
- Dermatology Department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Karim Aouam
- Pharmacology Department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Monia Youssef
- Dermatology Department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
| | - Jameleddine Zili
- Dermatology Department, Fattouma Bourguiba Hospital, University of Medicine, Monastir, Tunisia
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8
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Savic L, Stannard N, Farooque S. Allergy and anaesthesia: managing the risk. BJA Educ 2020; 20:298-304. [DOI: 10.1016/j.bjae.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 10/23/2022] Open
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9
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Virdee SS, Ravaghi V, Camilleri J, Cooper P, Tomson P. Current trends in endodontic irrigation amongst general dental practitioners and dental schools within the United Kingdom and Ireland: a cross-sectional survey. Br Dent J 2020:10.1038/s41415-020-1984-x. [PMID: 32855518 DOI: 10.1038/s41415-020-1984-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aims To investigate current trends in endodontic irrigation amongst general dental practitioners (GDPs) and dental schools within UK and Ireland. Secondly, to evaluate if significant differences exist between the irrigant practices of National Health Service (NHS) and private GDPs.Methodology In 2019, an online questionnaire was distributed to the 18 dental schools within the UK and Ireland and 8,568 GDPs. These surveys explored current trends in teaching and usage of endodontic irrigants. Chi-squared tests were performed to make comparisons between NHS and private GDPs (α <0.01).Results All 18 dental schools (100%) and 495 GDPs (6%) returned valid questionnaires. Three hundred and thirty (66.7%) practitioners were NHS and 165 (33.3%) were private. There was strong consensus on irrigation teaching amongst dental schools. These results aligned with GDP responses in terms of irrigant selection (sodium hypochlorite [NaOCl]); NaOCl concentration (≤3%); ethylenediaminetetraacetic acid (EDTA) contact time (>0-5 minutes); final rinse protocols (penultimate EDTA rinse); irrigant temperature (room); and agitation techniques (manual dynamic activation; >0-60 seconds). There was, however, considerable variation in NaOCl contact time and GDPs infrequently used chelating agents or agitation techniques. Compared with private practitioners, NHS GDPs used significantly lower NaOCl contact times and concentrations, less EDTA and activation techniques, and more chlorhexidine (P <0.01).Conclusions Overall, irrigation teaching within the UK and Ireland is consistent and evidence-based. Furthermore, trends in irrigant usage amongst UK GDPs are now more aligned with these teaching practices. Significant differences were, however, observed between NHS and private practitioners.
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Affiliation(s)
- Satnam Singh Virdee
- Clinical Lecturer & Speciality Registrar in Restorative Dentistry, PhD Student, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK; Part-Time General Dental Practitioner, Abbey House Dental Practice, 9 Abbey Street, Stone, ST15 8PA, UK.
| | - Vahid Ravaghi
- Lecturer in Dental Public Health, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK
| | - Josette Camilleri
- Reader in Restorative Dentistry, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK
| | - Paul Cooper
- Professor of Oral Biology, Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Phillip Tomson
- Senior Clinical Lecturer & Consultant in Restorative Dentistry, University of Birmingham, Mill Pool Way, Birmingham, B5 7EG, UK
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10
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Avison R, Fish B, Sholtysek S, Moor J, Gordins P, Holding S, Hibbert C, Khan S. Incorporation of chlorhexidine in alcohol skin swabs is not without risks of allergic reactions including anaphylaxis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:246-247. [PMID: 32105531 DOI: 10.12968/bjon.2020.29.4.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Rebecca Avison
- Senior Nurse, Immunology and Allergy, Queen's Center, Castle Hill Hospital, Cottingham
| | - Beverley Fish
- Senior Nurse, Immunology and Allergy, Queen's Center, Castle Hill Hospital, Cottingham
| | - Sarah Sholtysek
- Senior Nurse, Immunology and Allergy, Queen's Center, Castle Hill Hospital, Cottingham
| | - Jackie Moor
- Specialist Nurse, Immunology and Allergy, Queen's Center, Castle Hill Hospital, Cottingham
| | - Pavel Gordins
- Consultant Immunologist, Immunology and Allergy, Queen's Center, Castle Hill Hospital, Cottingham
| | - Steve Holding
- Consultant Clinical Scientist, Immunology and Allergy, Hull Royal Infirmary
| | - Caroline Hibbert
- Consultant Anaesthetist, Department of Anaesthesia, Hull Royal Infirmary, Hull
| | - Sujoy Khan
- Consultant Immunologist, Immunology and Allergy, Queen's Center, Castle Hill Hospital, Cottingham
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11
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Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Goossens A, Gonçalo M. Contact Allergy to Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Fernandes M, Lourenço T, Lopes A, Spínola Santos A, Pereira Santos MC, Pereira Barbosa M. Chlorhexidine: a hidden life-threatening allergen. Asia Pac Allergy 2019; 9:e29. [PMID: 31720240 PMCID: PMC6826114 DOI: 10.5415/apallergy.2019.9.e29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022] Open
Abstract
Chlorhexidine is a commonly used antiseptic and disinfectant in the health-care setting. Anaphylaxis to chlorhexidine is a rare but potentially life-threatening complication. Epidemiologic data suggest that the cases of chlorhexidine allergy appears to be increasing. In this article we report a life-threatening anaphylactic shock with cardiorespiratory arrest, during urethral catheterization due to chlorhexidine. The authors also performed a literature review of PubMed library of anaphylactic cases reports due to this antiseptic between 2014 and 2018, demonstrating the increase in the number of cases occurring worldwide and the importance of detailed anamnesis and appropriate diagnostic workup of allergic reactions to disinfectants.
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Affiliation(s)
- Mara Fernandes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Portugal.,Unidade de Imunoalergologia, Hospital Dr. Nélio Mendonça, SESARAM EPE, Funchal, Portugal
| | - Tatiana Lourenço
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Portugal
| | - Anabela Lopes
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Portugal
| | - Amélia Spínola Santos
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Portugal
| | - Maria Conceição Pereira Santos
- Laboratório de Imunologia Clínica, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Portugal.,Clínica Universitária de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Manuel Pereira Barbosa
- Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Portugal.,Clínica Universitária de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Portugal
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14
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Ho A, Zaltzman J, Hare GMT, Chen L, Fu L, Tarlo SM, Vadas P. Severe and near-fatal anaphylactic reactions triggered by chlorhexidine-coated catheters in patients undergoing renal allograft surgery: a case series. Can J Anaesth 2019; 66:1483-1488. [DOI: 10.1007/s12630-019-01441-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022] Open
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15
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Gu JQ, Liu S, Zhi YX. Provocation Test-Confirmed Chlorhexidine-Induced Anaphylaxis in Dental Procedure. Chin Med J (Engl) 2019; 131:2893-2894. [PMID: 30511701 PMCID: PMC6278190 DOI: 10.4103/0366-6999.246073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jian-Qing Gu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shuang Liu
- Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yu-Xiang Zhi
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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16
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Opstrup MS, Jemec GBE, Garvey LH. Chlorhexidine Allergy: On the Rise and Often Overlooked. Curr Allergy Asthma Rep 2019; 19:23. [PMID: 30874959 DOI: 10.1007/s11882-019-0858-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW In recent years, the risk of allergy to chlorhexidine is increasingly recognised. In this review, we discuss why the allergy is so easily overlooked and point out several preventative initiatives that can minimise the risk of both chlorhexidine sensitisation and allergy development and accidental re-exposure in patients with chlorhexidine allergy. Testing for chlorhexidine allergy is also discussed. RECENT FINDINGS Numerous reports have been published from many different specialties. Symptoms range from mild skin symptoms to life-threatening anaphylaxis. Testing for chlorhexidine allergy is based on skin testing and in vitro testing. Recently, it was found that both skin prick testing and specific IgE have high sensitivities and specificities. This review gives an overview of chlorhexidine allergy with a special focus on preventative initiatives and testing.
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Affiliation(s)
- Morten Schjørring Opstrup
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. .,Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Heise Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Opstrup MS, Garvey LH. Chlorhexidine Allergy: Mild Allergic Reactions Can Precede Anaphylaxis in the Healthcare Setting. Turk J Anaesthesiol Reanim 2019; 47:342-344. [PMID: 31380516 DOI: 10.5152/tjar.2019.22058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/26/2018] [Indexed: 11/22/2022] Open
Abstract
Chlorhexidine can cause severe immediate-type allergic reactions such as urticaria, anaphylactic shock or, even, cardiac arrest. We report the case of a patient who developed perioperative anaphylactic shock caused by chlorhexidine 1 year after a postoperative urticarial reaction, which was assumed not to be significant at the time. This case highlights the importance of identifying mild allergy symptoms after exposure to chlorhexidine at the pre-anaesthetic assessment to prevent more severe allergic reactions in future.
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Affiliation(s)
- Morten Schjørring Opstrup
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Lene Heise Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract
Summary We report three precautionary cases of perioperative anaphylaxis to chlorhexidine isopropyl alcohol antiseptic wipes (CAW). In two cases, the patients were inadvertently re-exposed to CAW despite known chlorhexidine hypersensitivity. Chlorhexidine has been described as ‘the hidden allergen’. As a result, patients may suffer multiple reactions before chlorhexidine is confirmed as the cause. Healthcare workers may not recognize that products they use for common clinical steps contain chlorhexidine. These cases highlight the need for constant vigilance to facilitate the safe management of patients with a history of chlorhexidine anaphylaxis.
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19
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Dyer JE, Taktak SY, Parkes AW, Garcez T, Gall Z. Chlorhexidine-related anaphylaxis in urological practice. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818788244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: There have been numerous case reports highlighting the risk of anaphylactic reactions when using chlorhexidine-containing urethral gels. However, there is no evidence that the inclusion of chlorhexidine in urethral gels reduces the risk of catheter associated urinary tract infection. Methods: Pubmed and Medline were searched for the keywords anaphylaxis (and) chlorhexidine. Case reports were reviewed and information regarding year, patient demographics, country, chlorhexidine administration route, signs, symptoms encountered and the presence of subsequent allergy testing were analysed. Results: In terms of clinical features, 89% (32/36) of patients were noted to have skin changes recorded as either urticaria, flushing, rash, erythema or wheals. Respiratory changes were recorded in 67% (24/36), which included those described as bronchospasm, chest tightness, wheeze or cough. Hypotension was documented in 92% of reports (33/36) while hypoxia was recorded in half of the reports (18/36) and a quarter (8/36) had periorbital angioedema or documented oral or tongue swelling. Only four out of 36 patients required formal cardiopulmonary resuscitation and no patients died. Conclusion: Chlorhexidine-related anaphylaxis is a relatively frequently reported entity. Despite this, there appears to be no compelling evidence that chlorhexidine mitigates the risk of catheter-associated urinary tract infection. Level of evidence: Level 4 evidence.
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Affiliation(s)
- James E Dyer
- Department of Urology, Stepping Hill Hospital, Stockport, UK
| | - Samih Y Taktak
- Department of Urology, Stepping Hill Hospital, Stockport, UK
| | - Andrew W Parkes
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - Tomaz Garcez
- Department of Clinical Immunology, Manchester Royal Infirmary, Manchester, UK
| | - Zara Gall
- Department of Urology, Stepping Hill Hospital, Stockport, UK
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20
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Cross-sectional study of perioperative drug and allergen exposure in UK practice in 2016: the 6th National Audit Project (NAP6) Allergen Survey. Br J Anaesth 2018; 121:146-158. [DOI: 10.1016/j.bja.2018.04.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/01/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022] Open
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21
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Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Br J Anaesth 2018; 121:159-171. [DOI: 10.1016/j.bja.2018.04.014] [Citation(s) in RCA: 290] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/30/2018] [Accepted: 04/13/2018] [Indexed: 12/25/2022] Open
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22
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Toletone A, Dini G, Massa E, Bragazzi NL, Pignatti P, Voltolini S, Durando P. Chlorhexidine-induced anaphylaxis occurring in the workplace in a health-care worker: case report and review of the literature. LA MEDICINA DEL LAVORO 2018; 109:68-76. [PMID: 29411737 PMCID: PMC7682154 DOI: 10.23749/mdl.v109i1.6618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chlorhexidine has been widely used in the occupational field as an effective antiseptic and disinfectant, especially in the health-care services. Several cases of allergic reactions to chlorhexidine have been reported, both in the general population and in workers. OBJECTIVES To describe a case of occupational chlorhexidine-induced severe anaphylaxis that occurred in the workplace in a health-care worker (HCW) and to update the literature on chlorhexidine as a possible occupational allergen. METHODS We report a case of a severe anaphylactic reaction that occurred in the workplace in a 63-year-old man, who had worked as a dentist for over 20 years. We also carried out a systematic review of the literature according to the PRISMA guidelines. No time or language filters were applied. Only occupational case-reports and case-series were included. RESULTS The causative role of chlorhexidine was suspected owing to the presence of chlorhexidine-containing products in the workplace. Positive results on the Basophil Activation Test confirmed the diagnosis of immediate chlorhexidine-induced hypersensitivity reaction and excluded a role of other disinfectants. No other causes of anaphylaxis were suspected. Our systematic literature review identified 14 cases of occupational chlorhexidine-induced allergy among HCWs; in these cases, the clinical presentation was mild and the symptoms resolved. No cases of systemic reactions in the workplace were reported. CONCLUSIONS This is the first report of chlorhexidine-induced severe anaphylaxis occurring in the workplace. This case report underlines the importance of investigating and being aware of individual and environmental risk factors in the occupational field, which can cause, albeit infrequently, severe reactions with serious consequences.
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Affiliation(s)
- Alessandra Toletone
- Department of Health Sciences (DISSAL), Postgraduate School in Occupational Medicine, University of Genoa, Italy.
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Anaphylaxis to invasive chlorhexidine administration despite tolerance of topical chlorhexidine use. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:1067-1069.e1. [PMID: 29226805 DOI: 10.1016/j.jaip.2017.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/25/2017] [Accepted: 11/06/2017] [Indexed: 11/24/2022]
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Method for Bacterial Growth and Ammonia Production and Effect of Inhibitory Substances in Disposable Absorbent Hygiene Products. J Wound Ostomy Continence Nurs 2017; 44:78-83. [PMID: 27749743 DOI: 10.1097/won.0000000000000275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a pragmatic laboratory method to provide a technique for developing incontinence products better able to reduce malodor when used in the clinical setting. METHODS Bacterial growth and bacterially formed ammonia in disposable absorbent incontinence products was measured by adding synthetic urine inoculated with bacteria to test samples cut from the crotch area of the product. The inhibitory effect's of low pH (4.5 and 4.9) and 3 antimicrobial substances-chlorhexidine, polyhexamethylene biguanide (PHMB), and thymol-at 2 concentrations each, were studied. RESULTS From the initial inocula of 3.3 log colony-forming units per milliliter (cfu/mL) at baseline, the bacterial growth of the references increased to 5.0 to 6.0 log cfu/mL at 6 hours for Escherichia coli, Proteus mirabilis, and Enterococcus faecalis. At 12 hours there was a further increase to 7.0 to 8.9 log cfu/mL. Adjusting the pH of the superabsorbent in the incontinence product from 6.0 to pH 4.5 and pH 4.9 significantly (P < .05) inhibited the bacterial growth rates, in most cases, both at 6 and 12 hours. The effect was most pronounced at pH 4.5. Chlorhexidine had significant (P < .05) inhibitory effect on E. coli and E. faecalis, and at 12 hours also on P. mirabilis. For PHMB and thymol the results varied. At 6 hours, the ammonia concentration in the references (pH 6.0) was 200 to 300 ppm and it was 1500 to 1600 ppm at 8 hours. At pH 4.5, no or little ammonia production was measured at 6 and 8 hours. At pH 4.9, there was a significant reduction (P < .01). Chlorhexidine and PHMB exerted a significant (P < .01 or P < .001) inhibitory effect on ammonia production at both concentrations and at 6 and 8 hours. Thymol 0.003% and 0.03% showed inhibitory effect at both 6 hours (P < .01 or P < .001) and at 8 hours (P < .05 or P < .001). CONCLUSION The method described in this study can be used to compare the ability of various disposable absorbent products to inhibit bacterial growth and ammonia production. This technique, we describe, provides a pragmatic method for assessing the odor-inhibiting capacity of specific incontinence products.
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Vu M, Rajgopal Bala H, Cahill J, Toholka R, Nixon R. Immediate hypersensitivity to chlorhexidine. Australas J Dermatol 2017; 59:55-56. [PMID: 28589697 DOI: 10.1111/ajd.12674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/09/2017] [Indexed: 11/26/2022]
Abstract
Chlorhexidine is a widely used and effective antiseptic agent. Although skin contact is usually well tolerated, it may cause both immediate and delayed hypersensitivity reactions. We report a case of immediate hypersensitivity to chlorhexidine causing both skin and respiratory symptoms following occupational exposure to chlorhexidine in a health-care worker.
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Affiliation(s)
- Mi Vu
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
| | - Harini Rajgopal Bala
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
| | - Jennifer Cahill
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
| | - Ryan Toholka
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
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Koychev S, Dommisch H, Chen H, Pischon N. Antimicrobial Effects of Mastic Extract Against Oral and Periodontal Pathogens. J Periodontol 2017; 88:511-517. [DOI: 10.1902/jop.2017.150691] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Stefka Koychev
- Department of Periodontology and Synoptic Dentistry, Charité Medical University of Berlin, Berlin, Germany
| | - Henrik Dommisch
- Department of Periodontology and Synoptic Dentistry, Charité Medical University of Berlin, Berlin, Germany
| | - Hong Chen
- Department of Periodontology and Synoptic Dentistry, Charité Medical University of Berlin, Berlin, Germany
- Department of Stomatology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Nicole Pischon
- Department of Periodontology and Synoptic Dentistry, Charité Medical University of Berlin, Berlin, Germany
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Perioperative Anaphylaxis to Chlorhexidine during Surgery and Septoplasty. Case Rep Otolaryngol 2017; 2017:9605804. [PMID: 28409044 PMCID: PMC5376445 DOI: 10.1155/2017/9605804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 11/17/2022] Open
Abstract
Chlorhexidine is an antiseptic and disinfectant used in surgical and clinical practice since 1954 and is available in aqueous or alcoholic solutions 0.5%-4.0% and has a broad-spectrum activity. Despite their widespread use, allergic reactions with chlorhexidine are rarely reported. We describe a case of anaphylaxis with chlorhexidine during a septoplasty, turbinectomy, and maxillary sinusectomy. The patient presented with periorbital edema, hives, hypotension, and wheezing. Immediately after the diagnosis of anaphylaxis promethazine, hydrocortisone, and epinephrine were administered with immediate clinical improvement. This case highlights the importance of assessing whether there is a previous clinical history of hypersensitivity to chlorhexidine in patients who will undergo surgical procedures.
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Kampf G, Kramer A, Suchomel M. Lack of sustained efficacy for alcohol-based surgical hand rubs containing ‘residual active ingredients’ according to EN 12791. J Hosp Infect 2017; 95:163-168. [DOI: 10.1016/j.jhin.2016.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
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Wilson M. Urinary catheterisation in the community: Exploring challenges and solutions. Br J Community Nurs 2016; 21:492-496. [PMID: 27715265 DOI: 10.12968/bjcn.2016.21.10.492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Mary Wilson
- Retired Nurse Practitioner for Bladder and Bowel Health, Humber NHS Foundation Trust
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Opstrup MS, Poulsen LK, Malling HJ, Jensen BM, Garvey LH. Dynamics of plasma levels of specific IgE in chlorhexidine allergic patients with and without accidental re-exposure. Clin Exp Allergy 2016; 46:1090-8. [PMID: 27079633 DOI: 10.1111/cea.12743] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/25/2016] [Accepted: 04/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chlorhexidine is an effective disinfectant, which may cause severe allergic reactions. Plasma level of specific IgE to chlorhexidine (ImmunoCAP(®) ) has high estimated sensitivity and specificity when measured within 6 months of allergic reaction, but knowledge of the dynamics over longer time periods is lacking and it is unknown whether levels fall below <0.35 kUA/L in patients with previously elevated levels. It is also unclear whether re-exposure influences levels of specific IgE. OBJECTIVE To investigate the dynamics of specific IgE in chlorhexidine allergic patients with and without re-exposure. METHODS All patients diagnosed with chlorhexidine allergy in the Danish Anaesthesia Allergy Centre January 1999 to March 2015 were invited to participate. The study included blood samples from the time of reaction and time of investigation and blood samples drawn prospectively over several years. RESULTS Overall, 23 patients were included. Specific IgE within hours of reaction was available in eight patients and was >0.35 kUA/L in six of these. During allergy investigations, usually 2-4 months later, specific IgE was >0.35 kUA/L in 22 of 23 patients. In the following months/years specific IgE declined <0.35 kUA/L in 17 of 23 patients (most rapidly within 4 months). Nine re-exposures in the healthcare setting were reported by seven patients (35%). Most re-exposures caused symptoms and were followed by an increase in specific IgE. Two patients with specific IgE <0.35 kUA/L reacted upon re-exposure. CONCLUSIONS & CLINICAL RELEVANCE Time from reaction should be considered when interpreting specific IgE results. Specific IgE is >0.35 kUA/L in most patients at time of reaction but should be repeated after a few weeks/months if negative. The optimal sampling time seems to be >1 month and <4 months. A value <0.35 kUA/L neither excludes allergy nor implies loss of reactivity in previously sensitized patients. Re-exposures are common, often iatrogenic, and can cause a rebound in specific IgE.
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Affiliation(s)
- M S Opstrup
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.,National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - L K Poulsen
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - H J Malling
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - B M Jensen
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - L H Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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Spoerl D, Jandus P, Harr T. Pitfalls and peculiarities in chlorhexidine allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:991-2. [PMID: 27130710 DOI: 10.1016/j.jaip.2016.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- David Spoerl
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Genève, Switzerland.
| | - Peter Jandus
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Genève, Switzerland
| | - Thomas Harr
- Division of Clinical Immunology and Allergy, Department of Medical Specialties, University Hospital and Faculty of Medicine, Genève, Switzerland
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Macy E. Practical Management of Patients with a History of Immediate Hypersensitivity to Common non-Beta-Lactam Drugs. Curr Allergy Asthma Rep 2016; 16:4. [PMID: 26714689 DOI: 10.1007/s11882-015-0584-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immediate hypersensitivity reactions to medications are among the most feared adverse drug reactions, because of their close association with anaphylaxis. This review discusses a practical management approach for patients with a history of an immediate hypersensitivity to a non-beta-lactam medication, where reexposure to the implicated, or similar, medication is clinically necessary. Mechanisms associated with severe immediate hypersensitivity reactions include IgE-mediated mast cell activation, complement-mediated mast cell activation, and direct mast cell activation. Immediate hypersensitivity reactions may also be mediated by vasodilators, other pharmacologic mechanisms, or be secondary to underlying patient-specific biochemical abnormalities such as endocrine tumors or chronic spontaneous urticaria. The key features in the reaction history and the biochemistry of the implicated medication are discussed. Most individuals with a history of immediate hypersensitivity to a medication, who require reuse of that drug, can be safely retreated with a therapeutic course of the implicated drug after a full-dose challenge, graded challenge, or desensitization, with or without premedication and/or any preliminary diagnostic testing, depending on the specific situation.
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Affiliation(s)
- Eric Macy
- Kaiser Permanente, Department of Allergy, 7060 Clairemont Mesa Blvd, San Diego, CA, 92111, USA.
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Perioperative Hypersensitivity Reactions: Diagnosis, Treatment and Evaluation. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0078-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Opstrup MS, Johansen JD, Zachariae C, Garvey LH. Contact allergy to chlorhexidine in a tertiary dermatology clinic in Denmark. Contact Dermatitis 2015; 74:29-36. [DOI: 10.1111/cod.12487] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/11/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Morten S. Opstrup
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Claus Zachariae
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Lene H. Garvey
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
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Sharp G, Green S, Rose M. Chlorhexidine-induced anaphylaxis in surgical patients: a review of the literature. ANZ J Surg 2015; 86:237-43. [PMID: 26361890 DOI: 10.1111/ans.13269] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 12/29/2022]
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%. DISCUSSION 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.
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Affiliation(s)
- Gary Sharp
- Department of General Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sarah Green
- Anaesthetic Allergy Service, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Rose
- Anaesthetic Allergy Service, Royal North Shore Hospital, Sydney, New South Wales, Australia
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The incidence of perioperative hypersensitivity reactions: a single-center, prospective, cohort study. Anesth Analg 2015; 121:117-123. [PMID: 25902325 DOI: 10.1213/ane.0000000000000776] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of perioperative hypersensitivity reactions, which can be life-threatening, ranges from 1 in 20,000 to 1 in 1361. These reactions are usually classified as IgE or non-IgE mediated. The aim of this study was to determine the incidence of allergic reactions during general anesthesia in our hospital, to establish the incidence of the allergic reactions for each drug used, to assess the frequency of IgE-mediated reactions in even mild reactions, and to compare the degree of agreement between anesthesiologist suspicion and allergy diagnosis. METHODS We included patients diagnosed with a clinical hypersensitivity reaction during a procedure under general anesthesia over a 30-month period (February 2008 to August 2010). Plasma histamine and serum tryptase concentrations were determined in these patients. We performed skin tests to diagnose the causative agent. Data from the hospital electronic prescribing system were collected to determine the ratio of reactions for each drug. RESULTS During the study period, 16,946 anesthetic procedures were performed (53% involved males; mean age, 51.6 years). Forty-four perianesthetic reactions were recorded, and the ratio of reactions was 1 in 385 operations (95% confidence interval, 1/529-1/287). Twenty-five reactions (25/44; 57%) occurred during the induction of anesthesia. Twenty-one reactions (21/44; 48%) were mild, involving only skin, and 23 of 44 (52%) were anaphylactic reactions. Four of 10 patients who had only a rash experienced IgE-mediated reactions. Five surgeries (11%) were suspended because of the severity of the reactions. Fifteen reactions (15/30; 50%) were IgE mediated, and, in 2 of 30 (7%), a non-IgE agent was found (cold urticaria and nonsteroidal anti-inflammatory drug intolerance). The ratio of reactions for each drug was as follows: protamine, 1 in 468; cisatracurium, 1 in 1388; amoxicillin-clavulanate, 1 in 1968; atracurium, 1 in 2039; and dipyrone, 1 in 3159. CONCLUSIONS Perioperative reactions are more common than previously reported. Mild hypersensitivity perioperative reactions-involving only skin-should be considered in evaluating patients because a substantial number of these reactions are IgE mediated.
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Steggall M, Jones K. Anaesthetic or lubricating gels for urethral catheterisation? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S12-S14. [PMID: 25978467 DOI: 10.12968/bjon.2015.24.sup9.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Martin Steggall
- Dean, Faculty of Life Sciences and Education, University of South Wales
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Moka E, Argyra E, Siafaka I, Vadalouca A. Chlorhexidine: Hypersensitivity and anaphylactic reactions in the perioperative setting. J Anaesthesiol Clin Pharmacol 2015; 31:145-8. [PMID: 25948890 PMCID: PMC4411823 DOI: 10.4103/0970-9185.155138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital, Heraklion-Crete, Greece
| | - Eriphili Argyra
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Ioanna Siafaka
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Athina Vadalouca
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
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Abstract
Chlorhexidine is an antiseptic agent, commonly used, in many different preparations, and for multiple purposes. Despite its superior antimicrobial properties, chlorhexidine is a potentially allergenic substance. The following is a review of the current evidence-based knowledge of allergic reactions to chlorhexidine associated with surgical and interventional procedures.
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Affiliation(s)
- Claude Abdallah
- Division of Anesthesiology, The George Washington University Medical Center, Children's National Medical Center, Washington, D. C. 20010-2970, USA
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Opstrup MS, Malling HJ, Krøigaard M, Mosbech H, Skov PS, Poulsen LK, Garvey LH. Standardized testing with chlorhexidine in perioperative allergy--a large single-centre evaluation. Allergy 2014; 69:1390-6. [PMID: 24957973 DOI: 10.1111/all.12466] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- M. S. Opstrup
- National Allergy Research Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
- Allergy Clinic; Danish Anaesthesia Allergy Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
| | - H.-J. Malling
- Allergy Clinic; Danish Anaesthesia Allergy Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
| | - M. Krøigaard
- Allergy Clinic; Danish Anaesthesia Allergy Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
| | - H. Mosbech
- Allergy Clinic; Danish Anaesthesia Allergy Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
| | - P. S. Skov
- Allergy Clinic; Danish Anaesthesia Allergy Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
| | - L. K. Poulsen
- Allergy Clinic; Danish Anaesthesia Allergy Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
| | - L. H. Garvey
- Allergy Clinic; Danish Anaesthesia Allergy Centre; Copenhagen University Hospital Gentofte; Gentofte Denmark
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Abstract
Perioperative anaphylaxis is a life-threatening condition with an estimated prevalence of 1:3,500 to 1:20,000 procedures and a mortality rate of up to 9 %. Clinical presentation involves signs such as skin rash, urticaria, angioedema, bronchospasm, tachycardia, bradycardia, and hypotension. Prompt recognition and treatment is of utmost importance to the patient's prognosis, since clinical deterioration can develop rapidly. Epinephrine is the main treatment drug, and its use should not be postponed, since delayed administration is associated with increased mortality. Elevated levels of serum tryptase help to confirm the diagnosis. The main agents involved in IgE-mediated perioperative anaphylaxis are neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids. Specific investigation should be conducted 4 to 6 weeks after the reaction and relies on skin tests, serum-specific IgE, and challenge procedures. This review aims to discuss the main aspects of perioperative anaphylaxis: risk factors, diagnosis, treatment, culprit agents, specific investigation, and preventive measures.
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Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M, UK Department of Health. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014; 86 Suppl 1:S1-70. [PMID: 24330862 PMCID: PMC7114876 DOI: 10.1016/s0195-6701(13)60012-2] [Citation(s) in RCA: 660] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London).
| | - J A Wilson
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - R J Pratt
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - M Golsorkhi
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Tingle
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Bak
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Browne
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Prieto
- Faculty of Health Sciences, University of Southampton (Southampton)
| | - M Wilcox
- Microbiology and Infection Control, Leeds Teaching Hospitals and University of Leeds (Leeds)
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