Contact urticaria from chlorhexidine

Wong, W. K.; Goh, C. J.; Chan, K. W.

doi:10.1111/j.1600-0536.1990.tb01508.x

Cited by 19 publications

(17 citation statements)

References 9 publications

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“…Allergic reactions to the use of detergents containing chlorhexidine gluconate on intact skin have been reported and can be severe, including dyspnea and anaphylactic shock (30,92,124,138,158,270,409,425,430,468,526,563). Some cases of contact urticaria have also occurred as a result of chlorhexidine use (141,617).…”

Section: Chlorhexidinementioning

confidence: 99%

Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

2004

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The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product

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Section: Chlorhexidinementioning

confidence: 99%

Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

2004

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“…Today, chlorhexidine is known to elicit allergic contact dermatitis (4)(5)(6)(7)(8)(9)(10)(11)19), including connubial contact dermatitis (12), generally after prolonged and repeated application. It can also cause contact urticaria (14,37,38), photosensitivity (5,13), fixed drug eruption (15) and occupational asthma (16). People at particular risk of contact allergy are, apart from medical staff, patients with leg ulcers and leg eczema (17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Chlorhexidine anaphylaxis: case report and review of the literature

Krautheim¹,

Jermann

Bircher³

2004

Contact Dermatitis

183

103

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Chlorhexidine is a widely used antiseptic and disinfectant. Compared to its ubiquitous use in medical and non-medical environments, the sensitization rate seems to be low. Multivarious hypersensitivity reactions to the agent have been reported, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions and photosensitivity reactions. An increasing number of immediate-type allergies such as contact urticaria, occupational asthma and anaphylactic shock have been reported. In the case report, we describe anaphylaxis due to topical skin application of chlorhexidine, confirmed by skin testing and sulfidoleukotriene stimulation test (CAST(R): cellular antigen stimulation test). The potential risk of anaphylactic reactions due to the application of chlorhexidine is well known, especially that application to mucous membranes can cause anaphylactic reactions and was therefore discouraged. The use of chlorhexidine at a 0.05% concentration on wounds and intact skin was so far thought to be safe. Besides our patient, only one other case of severe anaphylactic reaction due to application of chlorhexidine on skin has been reported. Hypersensitivity to chlorhexidine is rare, but its potential to cause anaphylactic shock is probably underestimated. This review should remind all clinicians of an important potential risk of this widely used antiseptic.

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“…Nach Chlorhexidinanwendung wurden allergische Kontaktekzeme [63], Kontakturtikaria [88] und anaphylaktische Soforttypreaktionen [62] berichtet. Diese scheinen jedoch seltener als nach Clioquinol bzw.…”

Section: Clioquinol (Chlorjodhydroxychinolinvioform)unclassified

Topische Antibiotika und Antiseptika

Höger

1998

Der Hautarzt

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᭤Vorteile der Lokaltherapie ᭤Unerwünschte Wirkungen ᭤Frequenz von Nebenwirkungen Zytotoxische Effekte besonders bei der Wundheilung beachten Lernziele • Kenntnis prinzipieller Vor-und Nachteile der topischen Anwendung von Antiseptika bzw. Antibiotika • Kenntnis der eingesetzten Substanzklassen, ihres antimikrobiellen Wirkspektrums und möglicher lokaler bzw. systemischer Nebenwirkungen • Kritische Beurteilung des Einsatzes topischer Antibiotika Infektiöse Hauterkrankungen zählen zu den häufigsten Dermatosen. Dementsprechend erfreuen sich topische Antibiotika und Antiseptika in der Dermatologie einer großen Beliebtheit. Sie werden bei nachgewiesenen oder vermuteten kutanen Infektionen, bei Akne und Rosazea sowie vielfach auch zur Prophylaxe kutaner Infektionen (nach Traumata oder postoperativ) eingesetzt. Die Indikationsstellung zur topischen antimikrobiellen Behandlung muß unter kritischer Abwägung von Nutzen und Risiken dieser Substanzen erfolgen. ᭤ Vorteile der antimikrobiellen Lokaltherapie gegenüber der systemischen Therapie sind • rascher Wirkungseintritt • höhere Wirkstoffkonzentrationen in der Epidermis • Vermeidung (bzw. Reduktion) systemischer Nebenwirkungen • Vermeidung einer intestinalen Resistenzselektion Diesen Vorteilen stehen mögliche ᭤ unerwünschte Wirkungen gegenüber: • Induktion einer Kontaktsensibilisierung • lokal toxische Effekte (Wundheilung) • resorptive Toxizität • Resistenzselektion innerhalb der kutanen Flora • Resistenzentwicklung gegenüber Systemantibiotika Die ᭤ Frequenz dieser Nebenwirkungen ist zum Teil sehr hoch: Kontaktsensibilisierungen gegenüber topischen Antibiotika werden bei bis zu 30% der Patienten mit Ulcera crurum und 15% der Patienten mit chronischer Otitis externa beoabachtet [68]. Bis zu 100% der aeroben Flora ist nach topischer Erythromycinbehandlung resistent gegenüber diesem Antibiotikum [39]. Zytotoxische Effekte topischer Antiseptika und Antibiotika sind insbesondere bei der Wundheilung zu bedenken [81, 86].

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Contact urticaria from chlorhexidine

Cited by 19 publications

References 9 publications

Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

Chlorhexidine anaphylaxis: case report and review of the literature

Topische Antibiotika und Antiseptika

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