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Warshaw EM, Han J, Kullberg SA, DeKoven JG, Adler BL, Silverberg JI, Houle MC, Pratt MD, Belsito DV, Yu J, Botto NC, Reeder MJ, Taylor JS, Atwater AR, Dunnick CA, DeLeo VA, Mowad CM. Patch Testing to Chlorhexidine Digluconate, 1% Aqueous: North American Contact Dermatitis Group Experience, 2015-2020. Dermatitis 2023; 34:501-508. [PMID: 37279017 DOI: 10.1089/derm.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background: Chlorhexidine is an antiseptic that may cause allergic contact dermatitis. Objectives: To describe the epidemiology of chlorhexidine allergy and characterize positive patch test reactions. Methods: This retrospective study analyzed patients patch tested to chlorhexidine digluconate 1% aqueous by the North American Contact Dermatitis Group, 2015-2020. Results: Of 14,731 patients tested to chlorhexidine digluconate, 107 (0.7%) had an allergic reaction; of these, 56 (52.3%) reactions were currently clinically relevant. Most (59%) reactions were mild (+), followed by strong (++, 18.7%) and very strong (+++, 6.5%). Common primary dermatitis anatomic sites in chlorhexidine-positive patients were hands (26.4%), face (24.5%), and scattered/generalized distribution (17.9%). Compared with negative patients, chlorhexidine-positive patients were significantly more likely to have dermatitis involving the trunk (11.3% vs 5.1%; P = 0.0036). The most commonly identified source category was skin/health care products (n = 41, 38.3%). Only 11 (10.3%) chlorhexidine reactions were occupationally related; of these, 81.8% were in health care workers. Conclusions: Chlorhexidine digluconate allergy is uncommon, but often clinically relevant. Involvement of the hands, face, and scattered generalized patterns was frequent. Occupationally related reactions were found predominantly in health care workers.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joohee Han
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
| | - Sara A Kullberg
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina C Botto
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chris M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Beaumont C, Darrigade AS, Barbaud A, Collet E, Raison-Peyron N, Bourrain JL, Assier H, Giordano-Labadie F, Bara-Passot C, Milpied B, Tétart F, Armingaud P, Castelain F, Benkalfate L, Boulard C, Delaunay J, Mathelier-Fusade P, Pecquet C, Pralong P, Vital-Durand D, Genillier Foin N, Lefèvre MA, Hacard F, Nosbaum A, Pasteur J, Valois A, Vigan M, Ferrier le Bouëdec MC. 102 cases of sensitization to an antiseptic containing chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol with different profiles of sensitization in adults and children. Contact Dermatitis 2022; 87:62-70. [PMID: 35213760 DOI: 10.1111/cod.14085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND An aqueous antiseptic containing "chlorhexidine digluconate /benzalkonium chloride /benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years. OBJECTIVES To evaluate the clinical and sensitization profiles of patients diagnosed with allergic contact dermatitis to CBB. METHODS We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB. RESULTS Seventy-one adults and thirty-one children were included. The lesions were extensive in 63 % of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%), and chlorhexidine digluconate in children (54.8%). 32.4% of the patients were sensitized to several components. CONCLUSION CBB is a cause of allergic contact dermatitis at all ages. The antiseptic's components should be tested. The sensitization profile seems to be different between adults and children. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Charlotte Beaumont
- Department of Dermatology, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Evelyne Collet
- Department of Dermatology, CHU, Dijon-Bourgogne, Dijon, France
| | - Nadia Raison-Peyron
- Department of Dermatology, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Jean-Luc Bourrain
- Department of Pneumology and Allergology, CHU Montpellier, Montpellier, France
| | - Haudrey Assier
- Department of Dermatology, CHU Henri Mondor, Créteil, France
| | | | | | - Brigitte Milpied
- Department of Dermatology, Hôpital Saint-André, CHU Bordeaux, Bordeaux, France
| | - Florence Tétart
- Department of Allergology, Centre Erik Satie, CHU Rouen, Rouen, France
| | | | - Florence Castelain
- Department of Dermatology, Hôpital Jean Minjoz, CHU Besançon, Besançon, France
| | | | - Claire Boulard
- Department of Dermatology, Hôpital Jacques Monod, CH Le Havre, Montivilliers, France
| | | | - Pascale Mathelier-Fusade
- Sorbonne Université, AP-HP, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Catherine Pecquet
- Sorbonne Université, AP-HP, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Pauline Pralong
- Department of Dermatology, Hôpital Nord, CHU Grenoble, La Tronche, France
| | | | | | | | - Florence Hacard
- Department of Allergology and Immunology, CHU, Lyon sud, Pierre Bénite, France
| | - Audrey Nosbaum
- Department of Allergology and Immunology, CHU, Lyon sud, Pierre Bénite, France
| | - Justine Pasteur
- Department of Dermatology, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Aude Valois
- Department of Dermatology, Hôpital d'instruction des armées Sainte Anne, Toulon, France
| | - Martine Vigan
- Department of Dermatology, Hôpital Jean Minjoz, CHU Besançon, Besançon, France
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Crosse KR. Pre-surgical hand preparation in veterinary practice. N Z Vet J 2021; 70:69-78. [PMID: 34586948 DOI: 10.1080/00480169.2021.1987348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this paper is to review the evidence for different methods of surgical hand preparation applicable to veterinary practice. Surgical hand preparation is an essential step in performing surgery as a veterinarian. Recommended protocols and products for surgical hand preparation have varied since its inception in the late 1800s. Many factors must be considered when assessing the efficacy, safety, and users' compliance with any available product. Traditional scrub methods employing chlorhexidine gluconate or povidone-iodine have been compared to alcohol-based rub protocols with respect to immediate and prolonged efficacy, safety, compliance, requirements for theatre furniture, cost and water usage. Although much of the comparative data has been generated in human medical facilities, extrapolation of the data to veterinary surgery is appropriate. Considerations for veterinary practice are specifically discussed. Overall, the benefits of alcohol-based rubs indicate that this should be the preferred method of pre-surgical hand preparation for veterinarians in all types of practice.
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Affiliation(s)
- K R Crosse
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Kuo CW, Chiu YF, Wu MH, Li MH, Wu CN, Chen WS, Huang CH. Gelatin/Chitosan Bilayer Patches Loaded with Cortex Phellodendron amurense/ Centella asiatica Extracts for Anti-Acne Application. Polymers (Basel) 2021; 13:polym13040579. [PMID: 33671908 PMCID: PMC7918957 DOI: 10.3390/polym13040579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 02/08/2023] Open
Abstract
Acne is a chronic inflammatory skin disease that often occurs with anaerobic Propionibacterium acnes (P. acnes). Anti-acne patches, made of hydrocolloid or hydrogel, have become a popular way of topical treatment. The outer water-impermeable layer of commercial patches might create hypoxic conditions and promote P. acnes growth. In this study, gelatin/chitosan (GC) bilayer patches were prepared at different temperatures that included room temperature (RT), −20 °C/RT, and −80 °C/RT. The most promising GC bilayer patch (−80 °C /RT) contained a dense upper layer for protection from bacteria and infection and a porous lower layer for absorbing pus and fluids from pimples. The anti-acne bilayer patch was loaded with Cortex Phellodendri amurensis (PA) and Centella asiatica (CA) extracts. PA extract could inhibit the growth of P. acnes and CA extract was reported to improve wound healing and reduce scar formation. Moreover, the water retention rate, weight loss rate, antibacterial activity, and in vitro cytotoxicity of the patches were investigated. The porous structure of the patches promoted water retention and contributed to absorbing the exudate when used on open acne wounds. The GC bilayer patches loaded with PA/CA extracts were demonstrated to inhibit the growth of P. acnes, and accelerate the skin fibroblast cell viability. Based on their activities and characteristics, the GC bilayer patches with PA/CA extract prepared at −80 °C/RT obtain the potential for the application of acne spot treatment.
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Affiliation(s)
- Chi-Wen Kuo
- Department of Pharmacy, Jen-Ai Hospital No. 483, Dong Rong Rd., Tali, Taichung 412, Taiwan;
- Department of Nursing, College of Nursing, Central Taiwan University of Science and Technology, 666 Buzi Rd., Beitun District, Taichung City 406, Taiwan
- School of Pharmacy, College of Pharmacy, China Medical University, 91 Hsueh Shih Rd., Taichung 404, Taiwan
| | - Yi-Fang Chiu
- Department of Medical Laboratory, Chung-Kang Branch, Cheng-Ching Hospital, 966 Section 4, Taiwan Avenue, Taichung 407, Taiwan; (Y.-F.C.); (M.-H.W.)
| | - Min-Hua Wu
- Department of Medical Laboratory, Chung-Kang Branch, Cheng-Ching Hospital, 966 Section 4, Taiwan Avenue, Taichung 407, Taiwan; (Y.-F.C.); (M.-H.W.)
| | - Ming-Hsien Li
- Department of Medical Laboratory Science and Technology, Central Taiwan University of Science and Technology, 666 Buzi Rd., Beitun District, Taichung City 406, Taiwan; (M.-H.L.); (C.-N.W.); (W.-S.C.)
| | - Cheng-Nan Wu
- Department of Medical Laboratory Science and Technology, Central Taiwan University of Science and Technology, 666 Buzi Rd., Beitun District, Taichung City 406, Taiwan; (M.-H.L.); (C.-N.W.); (W.-S.C.)
| | - Wan-Sin Chen
- Department of Medical Laboratory Science and Technology, Central Taiwan University of Science and Technology, 666 Buzi Rd., Beitun District, Taichung City 406, Taiwan; (M.-H.L.); (C.-N.W.); (W.-S.C.)
| | - Chiung-Hua Huang
- Department of Medical Laboratory Science and Technology, Central Taiwan University of Science and Technology, 666 Buzi Rd., Beitun District, Taichung City 406, Taiwan; (M.-H.L.); (C.-N.W.); (W.-S.C.)
- Correspondence:
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Quenan S, Piletta P. Hand dermatitis in healthcare workers: 15-years experience with hand sanitizer solutions. Contact Dermatitis 2020; 84:339-340. [PMID: 33152106 DOI: 10.1111/cod.13738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sandrine Quenan
- Division of Dermatology, University Hospital of Geneva, Geneva, Switzerland
| | - Pierre Piletta
- Division of Dermatology, University Hospital of Geneva, Geneva, Switzerland
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Ricciardo BM, Nixon RL, Tam MM, Radic RR, Ricciardo BJ. Allergic Contact Dermatitis to Dermabond Prineo After Elective Orthopedic Surgery. Orthopedics 2020; 43:e515-e522. [PMID: 32882052 DOI: 10.3928/01477447-20200827-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/08/2019] [Indexed: 02/03/2023]
Abstract
The Dermabond Prineo skin closure system (Ethicon, Somerville, New Jersey) is a wound closure device that combines a 2-octyl cyanoacrylate liquid adhesive and a self-adhesive polyester mesh. Although cyanoacrylates traditionally have been associated with low rates of sensitization, allergic contact dermatitis (ACD) to Dermabond products is being increasingly reported after orthopedic surgery. The authors describe the first case series of ACD to Dermabond Prineo where patch testing confirmed the diagnosis in all patients. Six patients who had suspected Dermabond Prineo ACD after lower limb orthopedic surgery were assessed. Of these patients, 5 had itching within 4 days of surgery and rash within 5 days. All 5 of these patients reported previous exposure to Dermabond products. All patients had removal of the adhesive and mesh earlier than planned and were treated with corticosteroids. In addition, 4 patients received systemic antibiotics; however, only 1 had a microbiologically confirmed superficial skin infection. In all patients, the dermatitis resolved within 2 weeks of dressing removal, with no adverse effect on the orthopedic outcome. Patch testing showed positive reactions to Dermabond Prineo glue for all patients. Orthopedic surgeons should be aware of the potential for ACD to Dermabond Prineo, especially among patients with previous exposure to Dermabond products. The authors discuss the risk factors for ACD to Dermabond Prineo in the orthopedic cohort and provide recommendations for prevention and management. [Orthopedics. 2020;43(6):e515-e522.].
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7
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Chakraborty S, Bhanja DB, Panigrahi A, Sil A. Postoperative patterned rash. Surgery 2020. [DOI: 10.1016/j.surg.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Hand Hygiene Among Health Care Workers During COVID-19 Pandemic: Challenges and Recommendations. Dermatitis 2020; 31:233-237. [DOI: 10.1097/der.0000000000000639] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Health care workers may be at risk of occupational allergic contact dermatitis because of their frequent exposure to medical hand skin cleansers. We identified American Contact Dermatitis Society Core 80 Allergens found in medical hand skin cleansers (waterless skin soaps, water-needed skin soaps, and skin disinfectants) in the United States and developed a list of "low-allergen" medical hand skin cleansers. Waterless skin soaps most commonly contained fragrance, tocopherol, and sodium benzoate. Top allergens in water-needed skin soaps included fragrance, chloroxylenol, propylene glycol, and cocamidopropyl betaine. The most common allergens identified in skin disinfectants were chlorhexidine, cocamide diethanolamine, and fragrance. We identified 11 waterless skin soaps that were free of American Contact Dermatitis Society Core 80 Allergens. Low-allergen products were also identified for water-needed skin soaps (2 products) and skin disinfectants (4 products). This information is accurate as of the date of publication; product availability and ingredients may change over time.
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Abstract
OBJECTIVE To determine the frequency of self-reported hand dermatitis and the factors influencing its prevalence among nursing students. METHODS Researchers collected demographic data and used a self-assessment form to identify dermatologic symptoms. The questionnaires were distributed to the students and collected again after the students completed the forms. RESULTS Hand dermatitis was present in 20.9% of nursing students. The most common symptoms were irritation/pruritus, redness/cracking, flaking/rash, swelling, and vesicles in hands. The grade of the student, the presence of allergy complaints, and medication used to treat dermatitis were statistically significantly associated with dermatitis prevalence. The use of gloves and cleansing agents used in handwashing were factors linked to hand dermatitis. CONCLUSIONS Hand dermatitis increases in parallel with the increase of clinical practice hours among nursing students. Familial and environmental factors also increase the risk of hand dermatitis.
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Barnes S, Stuart R, Redley B. Health care worker sensitivity to chlorhexidine-based hand hygiene solutions: A cross-sectional survey. Am J Infect Control 2019; 47:933-937. [PMID: 30765146 DOI: 10.1016/j.ajic.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Health service hand hygiene programs have seen widespread use of chlorhexidine solutions. Reports of both immediate and delayed hypersensitivity to chlorhexidine are increasing among health care workers. This study examined the prevalence of self-reported symptoms of sensitivity to chlorhexidine solutions among health care workers. METHODS This study was a cross-sectional online anonymous survey of all workers at a single health service. RESULTS Of the 1,050 completed responses, 76.3% were female, 35.3% were nurses and midwives, 28% were medical staff, and 8.7% were working in nonclinical areas. Over 95% used chlorhexidine-based hand hygiene products in their workplace. Nurses and midwives most frequently reported asthma (13.7%), contact dermatitis (27.8%), and previous testing for allergy to chlorhexidine (4.9%). There was a correlation between both the presence of atopy, eczema, or dermatitis and the self-reporting of dry skin, eczema, or dermatitis attributed to chlorhexidine use. DISCUSSION Occupational chlorhexidine allergy is an important risk to health care workers. Self-reported symptoms of sensitivity to chlorhexidine solutions revealed high reported use and presence of skin symptoms among health care workers. CONCLUSIONS Screening programs need to identify nurses who develop chlorhexidine sensitivity due to occupational exposure. Strategies to mitigate risk should provide alternatives for those with sensitization.
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Chlorhexidine allergy in the perioperative setting: a narrative review. Br J Anaesth 2019; 123:e95-e103. [PMID: 30955832 DOI: 10.1016/j.bja.2019.01.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/04/2019] [Accepted: 01/26/2019] [Indexed: 02/03/2023] Open
Abstract
Chlorhexidine is an antiseptic with a broad spectrum of activity and a persistent effect on skin. Consequently, it has become an ubiquitous antiseptic in healthcare and the community. As use has become widespread, increasing numbers of cases of allergy have been reported in the literature, including cases of anaphylaxis to chlorhexidine gels used on mucous membranes, chlorhexidine-impregnated devices such as central venous catheters, chlorhexidine preparations used on wounds and broken skin, and cases after dental procedures. Numerous governmental warnings have been issued over recent decades to warn of the risk of allergy to chlorhexidine on mucosal surfaces or in medical devices. Whilst the number of published cases likely underestimates the true prevalence of reactions, we retrospectively surveyed clinics with experience in investigating perioperative chlorhexidine allergy. Despite differences in investigation practice before the survey took place, 13 clinics responded which together had diagnosed 252 cases of anaphylaxis to chlorhexidine, and cases of delayed allergy. In eight of 13 clinics, chlorhexidine was within the top four most commonly diagnosed causes of perioperative anaphylaxis. Despite this, the incidence of anaphylaxis to chlorhexidine is low given that patients are very commonly exposed. Sensitisation of healthcare workers can occur, but is uncommon. Before exposing patients to this antiseptic, consideration of the potential risk vs benefit should be undertaken, particularly for higher risk exposures, such as mucosal exposure or i.v. exposure via impregnated lines. Difficulties exist in protecting patients with known allergies from re-exposure to chlorhexidine, which would be improved with uniform labelling and chlorhexidine product registers.
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Darrigade A, Léauté-Labrèze C, Boralevi F, Taïeb A, Milpied B. Allergic contact reaction to antiseptics in very young children. J Eur Acad Dermatol Venereol 2018; 32:2284-2287. [DOI: 10.1111/jdv.15140] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- A.S. Darrigade
- Department of Adult and Pediatric Dermatology; Bordeaux University Hospitals; Bordeaux France
| | - C. Léauté-Labrèze
- Department of Adult and Pediatric Dermatology; Bordeaux University Hospitals; Bordeaux France
| | - F. Boralevi
- Department of Adult and Pediatric Dermatology; Bordeaux University Hospitals; Bordeaux France
| | - A. Taïeb
- Department of Adult and Pediatric Dermatology; Bordeaux University Hospitals; Bordeaux France
| | - B. Milpied
- Department of Adult and Pediatric Dermatology; Bordeaux University Hospitals; Bordeaux France
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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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Watts TJ, Li PH, Ue KL, Haque R. Chronic Allergic Contact Dermatitis Due to Chlorhexidine. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:254-255. [DOI: 10.1016/j.jaip.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 12/28/2022]
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Brandt ML. Sustaining a career in surgery. Am J Surg 2017; 214:707-714. [PMID: 28693842 DOI: 10.1016/j.amjsurg.2017.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
Abstract
Surgery is a demanding career with great rewards and equally great challenges. In order to sustain our careers as well as the careers of our colleagues, it is important to understand and address the physical, psychological and spiritual challenges of surgery. With rare exception, the majority of surgery residents and practicing surgeons who prematurely leave surgery do so because they find the work to be physically, emotionally or spiritually incompatible with the vision they have for their life. Understanding these issues and providing solutions to improve surgeon wellness can help prevent societal loss of these highly trained professionals and suffering for surgeons and their families.
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Affiliation(s)
- Mary L Brandt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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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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Cook KA, Kelso JM. Surgery-Related Contact Dermatitis: A Review of Potential Irritants and Allergens. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1234-1240. [PMID: 28396114 DOI: 10.1016/j.jaip.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/06/2017] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
Surgical procedures utilize an increasing number of medical products including antiseptics, anesthetics, gloves, suture materials, tissue adhesives, topical antibiotics, and bandages. Many of these products have irritant potential. Allergic contact dermatitis has also been reported. This review covers preoperative, operative, and postoperative exposures that may result in contact dermatitis. Testing with standard patch panels such as T.R.U.E. Test and the North American Contact Dermatitis Group 65 allergen series does not evaluate for all relevant contactants. A thorough understanding of potential exposures is vital to effectively evaluate a patient with surgery-related contact dermatitis. A systematic approach is needed to ensure that standard patch panels and supplementary patches adequately address each encountered contactant.
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Affiliation(s)
- Kevin A Cook
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
| | - John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
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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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22
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Hagen SL, Grey KR, Hylwa SA. Allergic contact dermatitis to Dermabond™: A case and review of the literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.wndm.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Ibler KS, Jemec GBE, Garvey LH, Agner T. Prevalence of delayed-type and immediate-type hypersensitivity in healthcare workers with hand eczema. Contact Dermatitis 2016; 75:223-9. [DOI: 10.1111/cod.12587] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Kristina S. Ibler
- Department of Dermatology, Roskilde Hospital; University of Copenhagen; 4000 Roskilde Denmark
- Department of Dermatology, Bispebjerg Hospital; University of Copenhagen; 2400 Copenhagen Denmark
| | - Gregor B. E. Jemec
- Department of Dermatology, Roskilde Hospital; University of Copenhagen; 4000 Roskilde Denmark
| | - Lene H. Garvey
- Allergy Clinic; Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Tove Agner
- Department of Dermatology, Bispebjerg Hospital; University of Copenhagen; 2400 Copenhagen Denmark
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Engebretsen KA, Hald M, Johansen JD, Thyssen JP. Allergic contact dermatitis caused by an antiseptic containing cetrimide. Contact Dermatitis 2015; 72:60-1. [PMID: 25524123 DOI: 10.1111/cod.12303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kristiane A Engebretsen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte University Hospital, University of Copenhagen, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark
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Mariyaselvam M, Hodges E, Richardson J, Steel A, Moondi P, Young P. The coated antiseptic tip (CAT) syringe. J Med Eng Technol 2015; 39:259-63. [PMID: 25970696 DOI: 10.3109/03091902.2015.1040895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Catheter-related blood stream infections (CR-BSI) account for 30% of healthcare acquired infection (HAI). Colonization of connector hubs and contaminated syringes are thought to increase the risk of CR-BSI. The Coated Antiseptic Tip (CAT) syringe was developed to decontaminate connector hubs, thereby reducing the risk of CR-BSI. Needleless valves (n = 20) and three-way connectors (n = 20) were contaminated with common critical care pathogens. At hourly intervals, CAT syringes were inserted into the connector hubs and normal saline was injected through the connector. This was repeated with control (non-coated) syringes. The internal surface of the connector hubs were swabbed at t = 0, t = 1 h and t = 4 h, inoculated onto blood agar plates and analysed by a blinded microbiologist. Growth was counted as the number of colony forming units. Baseline swabbing demonstrated 100% bacterial hub colonization in both connectors. The CAT syringe showed a significant reduction in CFU growth at 0 and 1 h compared with control syringes (p < 0.05). At 4 h, the CAT syringe completely eliminated bacterial growth in both of the connector hubs. The CAT syringe can effectively disinfect both three-way and needleless connectors.
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Affiliation(s)
- Maryanne Mariyaselvam
- The Critical Care Department, The Queen Elizabeth Hospital NHS Trust , Kings Lynn , UK
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Sadakane K, Ichinose T. Effect of the hand antiseptic agents benzalkonium chloride, povidone-iodine, ethanol, and chlorhexidine gluconate on atopic dermatitis in NC/Nga mice. Int J Med Sci 2015; 12:116-25. [PMID: 25589887 PMCID: PMC4293176 DOI: 10.7150/ijms.10322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/24/2014] [Indexed: 01/12/2023] Open
Abstract
Antiseptic agents can cause skin irritation and lead to severe problems, especially for individuals with atopic diatheses. We investigated the effect of 4 different antiseptic agents using an atopic dermatitis (AD) model mouse. NC/Nga mice were subcutaneously injected with mite allergen (Dp) to induce AD-like skin lesions (ADSLs), and an application of 0.2% (w/v) benzalkonium chloride (BZK), 10% (w/v) povidone-iodine (PVP-I), 80% (v/v) ethanol (Et-OH), or 0.5% (v/v) chlorhexidine gluconate (CHG) was applied to the ear envelope. BZK induced a significant increase in the severity of the clinical score, infiltration of inflammatory cells, local expression of inflammatory cytokines in subcutaneous tissue, and total serum immunoglobulin (Ig) E. PVP-I increased the clinical score, number of mast cells, and production of inflammatory cytokines, and total serum IgE. Et-OH increased the clinical score and number of inflammatory cells, but showed no effect on serum IgE levels. No differences in any parameters were observed between CHG and the vehicle. Collectively, the results suggest the severity of the ADSL was related in part to the strength of the immunoreaction. These findings suggest that CHG could offer the lowest risk of inducing ADSL in individuals with atopic dermatitis and that medical staff and food handlers with AD could benefit from its use.
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Affiliation(s)
- Kaori Sadakane
- Department of Health Sciences, Oita University of Nursing and Health Sciences, 2944-9 Megusuno, Oita City, Oita 870-1201, Japan
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