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Review of allergic reactions from use of chlorhexidine on medical products in clinical settings over 40 years: Risks and mitigations

Published online by Cambridge University Press:  03 June 2021

Bahgat Z. Gerges ,
Joel Rosenblatt ,
Y-Lan Truong ,
Ruth A. Reitzel  and
Isaam Raad
Bahgat Z. Gerges
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas, MD Anderson Cancer Center, Houston, Texas
Joel Rosenblatt*
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas, MD Anderson Cancer Center, Houston, Texas
Y-Lan Truong
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas, MD Anderson Cancer Center, Houston, Texas
Ruth A. Reitzel
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas, MD Anderson Cancer Center, Houston, Texas
Isaam Raad
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas, MD Anderson Cancer Center, Houston, Texas
*
Author for correspondence: Joel Rosenblatt, E-mail: JSRosenblatt@mdanderson.org
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Abstract

Chlorhexidine is an antimicrobial agent widely used for infection prevention in medical settings. Nevertheless, allergic reactions ranging from mild to severe have been reported following its use. In this review, we analyzed all case reports published between the introduction of chlorhexidine and the end of 2019 for allergic responses associated with the use of medical devices and or other medical products containing chlorhexidine (CHX) to ascertain the prevalence of severe CHX allergic reactions and what practices might best mitigate those risks.

In total, 77 publications containing 124 reported cases of allergic reactions were grouped into 3 product categories, catheters, semisolids, and fluid products. The country, type of reaction, route of sensitization, allergy confirmation, and intervention or mitigation was extracted for each case. Overall, 30 cases were associated with catheters, 46 cases were associated with semisolid products, and 48 cases were associated with the use of other medical products. Severe cases were managed with intravenous fluids, steroids, and epinephrine (adrenaline). None of the reported cases were fatal. The allergy risks can be mitigated by better warning and training clinicians and by recording and screening patient histories for CHX presensitization from prior exposure. For patients undergoing pre-use blood tests, IgE antibody screens can also be performed. Finally, as a precaution in the event a rare severe allergic reaction occurs, procedure carts and rooms can be prestocked with injectable epinephrine and other rapidly acting anti-inflammatory medications.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 6 , June 2022 , pp. 775 - 789
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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