Chlorhexidine: a hidden life-threatening allergen
Mara Fernandes, Tatiana Lourenço, Anabela Lopes, Amélia Spínola Santos, Maria Conceição Pereira Santos3, and Manuel Pereira Barbosa
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.
CASE REPORT
A 75-year-old male with hypertension receiving beta-blocker and bladder cancer underwent transurethral tumor resection in 2014. Surveillance postsurgical cystoscopy under local anesthesia was performed every 6 months. During the 2nd procedure he developed generalized cutaneous pruritus with no other symptoms with spontaneous resolution after one hour. This reaction was interpreted as allergy to cefoxitin and it was recommended to avoid 2nd generation cephalosporins.
Twenty minutes after the 4th cystoscopy, he developed generalized urticaria, oropharyngeal tightening, dyspnea, hypotension (75/40 mmHg) and loss of consciousness with cardiorespiratory arrest. Cardiopulmonary resuscitation was initiated immediately with endovenous administration of adrenaline (1 mg), clemastine (2 mg) and hydrocortisone (200 mg) and orotracheal intubation with invasive ventilation. The patient recovered over the next 2 hours and was extubated on the same day.
Asia Pac Allergy. 2019 Oct;9(4):e29 https://doi.org/10.5415/apallergy.2019.9.e29 pISSN 2233-8276·eISSN 2233-8268
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