Rare case of type I hypersensitivity reaction to sodium hypochlorite solution in a healthcare setting

Abstract

Sodium hypochlorite is a clear yellowish solution with a characteristic odour of chlorine and is commonly used as a disinfectant and a bleaching agent. It is used in various healthcare settings for its fast-acting and broad-spectrum antimicrobial activity. It is a known irritant and there are some reports that it can also cause allergic contact dermatitis of type IV hypersensitivity. We report a case of work-related type I hypersensitivity to sodium hypochlorite, presenting with recurrent urticarial rash and a positive prick test reaction to this chemical. He was subsequently excused from further exposure with no further recurrences of the urticarial rash. To the best of our knowledge, this is the first such reported case due to work in the healthcare setting.

Hypochlorous Acid: From Innate Immune Factor and Environmental Toxicant to Chemopreventive Agent Targeting Solar UV-Induced Skin Cancer

“…Likewise, signaling cascades including MAPKs (p38, ERK1/2) are sensitive to HOCl exposure attributed in part to tyrosine phosphatase modulation through cysteine-oxidation (139,140). Also, in the context of balancing HOCl-related organ toxicity and therapeutic effects, it should be mentioned that the indiscriminate HOCl-dependent induction of chlorination stress might be associated with adverse irritant effects (51,(141)(142)(143)(144).…”

“…Remarkably, in addition to endogenous and environmental sources, skin HOCl exposure also occurs through application of topical disinfectants employed worldwide as clinical and consumer products (167)(168)(169)(170)(171). In human skin (as a function of concentration, pH, and exposure time), irritation and disruption of barrier function, alteration of the commensal microbiome, allergy, and contact hypersensitivity are expected outcomes of inappropriate topical HOCl product use not compliant with standard of care (Figure 5D) (142,143). Also, it has been hypothesized that DBPs in drinking water correlate with risk of skin cancer (172).…”

Wound Antiseptics and European Guidelines for Antiseptic Application in Wound Treatment

“…In contrast, irritation of the skin and necrosis is observed in concentrations 5-10%. Allergic reactions and dermatitis may be observed in patients using NaOCl [68][69][70]. Persons with hypersensitivity to sodium hypochlorite may experience symptoms such as swelling, pain, breathing problems [71][72][73].…”

Efeito de diferentes protocolos para higienização de próteses totais sobre a Estomatite relacionada à Prótese, biofilme, carga microbiana e odor - estudo clínico aleatorizado e controlado

“…Embora a eficácia do hipoclorito de sódio como agente higienizador das próteses, mesmo em baixas concentrações, tenha sido demonstrada em outros estudos, sua indicação é limitada , ARRUDA et al, 2018BADARÓ et al, 2020). Pacientes que utilizam próteses com componentes metálicos (próteses removíveis parciais ou próteses removíveis com componentes metálicos em implantes -overdentures), ou com sensibilidade ao agente químico, não podem usar este desinfetante (CRINCOLI, et al, 2008;FELIPUCCI et al, 2011;CHIA SHI ZHE et al, 2016;KÜRKCÜOĞLU et al, 2016). Apesar das limitações, o hipoclorito de sódio foi utilizado como controle positivo porque identificamos que há evidências na literatura que sustentam sua eficácia em relação às variáveis analisadas ARRUDA et al, 2017;ARRUDA et al, 2018;BADARÓ et al, 2020).…”

“…Dentre eles, o hipoclorito, mesmo em baixas concentrações (0,25%, 0,2%) (JURCZYK et al, 2016;ARRUDA et al, 2017) preenche quase todos os requisitos exigidos pela Council on Dental Materials (Council On Dental Materials, 1983), uma vez que é eficaz na remoção do biofilme e eliminação dos microrganismos, é de baixo custo e pode ser facilmente implementado (DE SOUSA PORTA et al, 2015). Entretanto, pode causar hipersensibilidade e alergia nos pacientes (CHIA SHI ZHE et al, 2016;GUIVARC'H et al, 2017), além de possuir odor desagradável e causar manchamento de roupas e tecidos, interferindo assim, na adesão ao uso. Além disso, o hipoclorito é contraindicado para próteses parciais removíveis por causar a oxidação do metal (FELIPUCCI et al, 2011;PISANI et al, 2012;AMIN et al 2014;FREIRE et al, 2014;PARANHOS et al, 2013;NEPPELENBROEK et al, 2015).…”