Incorporation of chlorhexidine in alcohol skin swabs is not without risks of allergic reactions including anaphylaxis

Life-threatening chlorhexidine anaphylaxis caused by skin preparation before chlorhexidine-free central venous catheter insertion: a case report and literature review

Chlorhexidine is a common cause of perioperative anaphylaxis, and global regulatory authorities have issued warnings about anaphylaxis due to chlorhexidine-containing central venous catheters (CVC) and its mucosal absorption. We present a case of life-threatening anaphylaxis after CVC insertion caused by chlorhexidine used for skin preparation. The onset of anaphylaxis was rapid and very severe, resulting in pulseless electrical activity. The patient was successfully resuscitated by emergency veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Our case suggests that even skin preparation before chlorhexidine-free CVC insertion can cause life-threatening anaphylaxis. We reviewed the literature on chlorhexidine anaphylaxis cases and categorized all potential routes of chlorhexidine exposure to assess the risk following skin preparation. Our results showed that skin preparation before CVC insertion was the third most common cause of chlorhexidine anaphylaxis after transurethral exposure and chlorhexidine-containing CVCs. However, skin preparation with chlorhexidine before CVC insertion was sometimes overlooked as a cause of chlorhexidine anaphylaxis, and its risk might be underestimated. Further, no previous reports have described life-threatening anaphylaxis solely due to chlorhexidine skin preparation before CVC insertion. CVC insertion might cause the chlorhexidine used for skin preparation to reach the vascular system and should be recognized as a potential cause of life-threatening chlorhexidine anaphylaxis.

Antiseptic drugs and disinfectants with special scrutiny of COVID-19 pandemic related side effects

This review covers publications during the period of January 2020 to December 2020 on adverse reactions to antiseptic drugs and disinfectants. Specific agents discussed are alcohols (ethanol, isopropanol), aldehydes (formaldehyde), guanidines (chlorhexidine, polyhexamethylene guanidine, and polyhexamethylene biguanidine), benzalkonium compounds, triclocarban, povidone-iodine, and sodium hypochlorite. No new data were identified for glutaraldehyde, cetrimide, ethylene oxide, tosylchloramide, triclosan, iodine, and phenolic compounds. The use of antiseptic drugs and disinfectants has been considerably increased during 2020 in a variety of medical and occupational settings, in commerce and gastronomy, as well as in the household, due to their antiviral properties against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the Coronavirus Disease 2019 (COVID-19) pandemic. Exposure was additionally increased by widespread misinformation on social media for non-evidence based disinfectant use, even including ingestion or injection, as well as by questionable practices such as environmental spraying or disinfectant gates. Irritant effects on the respiratory system, skin and eyes were the most common adverse reaction, while the widespread and sometimes excessive use led to increased reports of poisonings, as well as cases of disinfectant adulteration including dilution into ineffective concentrations or addition of toxic agents such as methanol.