Platinum OpinionChlorhexidine: A New Latex?
Section snippets
Case study
A 73-yr-old man underwent transurethral resection of the prostate under spinal anaesthesia. He had 3 ml of 0.5% bupivacaine (Marcaine Heavy; AstraZeneca, London, UK) administered intrathecally. Block was achieved at T10, and he was transferred to theatre. Systolic blood pressure was 120–130 mm Hg with a heart rate (HR) of 70 beats per minute (bpm). He was given a bolus of 160 mg gentamicin intravenously. Instillagel (lidocaine hydrochloride 2 g/100 g and chlorhexidine gluconate 0.25 g/100 mg;
Discussion
Antisepsis changed the face of modern medicine, but universal precautions were introduced only in 1985 with the advent of the AIDS epidemic. Latex gloves and topical disinfectants were an essential part of those measures [1].
Accidental discovery of CHX [2] (Fig. 1) during a quest for a new antimalarial was the beginning of a true success story. This broad-spectrum biocide with a kill rate faster than other antiseptics became available in the United Kingdom as early as 1954. In 1981, the first
Conflicts of interest
The authors have nothing to disclose.
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Addressing the challenges in antisepsis: focus on povidone iodine
2020, International Journal of Antimicrobial AgentsCitation Excerpt :In recent years there has been a surge in confirmed cases of anaphylaxis caused by CHG, yet awareness of CHG as an allergen has been found to be low [94]. Diagnosis is easy to miss but presentation can be severe and occur at any time [95], and increased awareness of CHG allergy is needed in healthcare settings [95]. In terms of irritation, PVP-I 10% was significantly less irritating on the skin than CHG 5% [2].
Urticaria, Angioedema, and Anaphylaxis
2019, Clinical Immunology: Principles and PracticeCross-sectional study of perioperative drug and allergen exposure in UK practice in 2016: the 6th National Audit Project (NAP6) Allergen Survey
2018, British Journal of AnaesthesiaCitation Excerpt :Our data provide additional evidence of the use of second-line antibiotics, namely, teicoplanin, driven by drug allergy history, adding further strength to calls from the international allergy community for robust programmes to tackle inaccurate labels of antibiotic allergy, improving antibiotic stewardship.33–36 Chlorhexidine is a widely used antiseptic37 that has been increasingly reported as an emerging cause of allergy and perioperative anaphylaxis.38–43 Its use in the perioperative setting and its potential to cause anaphylaxis might be underestimated.44–46
Review of allergic reactions from use of chlorhexidine on medical products in clinical settings over 40 years: Risks and mitigations
2022, Infection Control and Hospital EpidemiologyApproach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management
2021, Current Allergy and Asthma Reports