Behçet disease is a multisystem vasculitis characterised by recurrent oral ulceration in conjunction with other manifestations. Neurological involvement or neuro-Behçet disease is not common, but typically affects young men at its onset between the ages of 20 and 40 with significant long-term morbidity and mortality. There is substantial case literature to support the use of tumour necrosis factor antagonists, notably infliximab, in the treatment of neuro-Behçet disease.

Background Chlorhexidine is an antiseptic widely used in healthcare settings. There are increasing reports of significant hypersensitivity reactions associated with its use. Development of chlorhexidine allergy has been identified as an important occupational risk to healthcare workers (HCWs). Aims To evaluate the prevalence of sensitization to chlorhexidine amongst HCWs at a large tertiary hospital to assess the potential allergic safety risks associated with chlorhexidine exposure to staff. Methods Sensitization to chlorhexidine was evaluated by measurement of serum-specific immunoglobulin E (IgE) in samples collected from staff assessed after a sharps-injury incident and laboratory staff collected for quality assurance procedures. This test method has been shown to have high sensitivity and specificity in the diagnosis of chlorhexidine allergy. Prevalence of sensitization was additionally evaluated with reference to changes in exposure to chlorhexidine-based hand hygiene products because of infection control procedures and the coronavirus disease 2019 pandemic. Results A total of 320 samples were examined. The prevalence of positive chlorhexidine-specific IgE was 2%. Prevalence of sensitization in samples collected before and after increased chlorhexidine exposure was 1% and 3%. This did not represent a statistically significant difference. Conclusions The prevalence figures for chlorhexidine sensitization in this study are higher than have been estimated previously for similar HCW cohorts. Increased exposure to chlorhexidine-based hand hygiene products was not demonstrated to increase sensitization in this group. Given the risk of severe reactions in sensitized individuals, this study indicates that evaluation of chlorhexidine allergy is important when investigating occupational allergy in HCWs.

phenotypes may provide clues regarding the pathogenesis and prevention of subsequent asthma. The odds ratio (OR) of a diagnosis of MMA where sIgE to alpha-gal is positive is only 2.5 (95% CI 0.7-8.6, P = 0.16). The OR of the presence of atopy is 1.3 (95% CI 0.5-3.3, P = 0.64). However, the OR for a history of tick bite is 15.4 (95% CI 5.3-45.3, P < 0.001).Conclusions: sIgE to alpha-gal does not add any further information to clinical history in the diagnosis of MMA. It only confirms that the patient has had a tick bite (in our population by Ixodes holocyclus). In our experience, this can be ascertained by the individual or at a clinical review. A reduction in the number of assays to sIgE to alpha-gal performed would reduce costs to these tick-endemic communities.