engleski

Contact urticaria syndrome due to chlorhexidine gluconate used during cystoscopy

Chlorhexidine is an effective antiseptic agent that is widely used in the healthcare setting. It is a frequent constituent of various solutions used for surgical washing, wound dressings as well as an additive in the gel used to facilitate urethral catheterization and passage of instruments into the bladder in urological practice. In a small subset of patients, it may lead to severe immediate-type allergic reactions such as urticaria and anaphylactic shock. Moreover, patients who are repeatedly exposed to chlorhexidine subsequently increase their risk of developing sensitivity reactions. We present a case of a 73-year old man who was referred to our clinic due to sudden onset of edema, erythema, and itch of the lower abdominal and peri-genital regions accompanied by facial edema and itchy, erythematous palms. The symptoms appeared one hour after cystoscopy, which was performed as part of a regular urological follow up due to history of bladder carcinoma. Complete remission of the rash and angioedema was achieved upon administration of parenteral glucocorticoids and antihistamines over a duration of two days. Even though the patient had uneventful previous five cystoscopies, a type I allergy to some of the perioperatively used agents was suspected. Most of the disinfectants used for surgical washing of the genital area as well as the gel used to facilitate the passage of the cystoscope contained chlorhexidine gluconate. Open application test to 4.5% chlorhexidine gluconate and closed (20 minutes) patch testing to 1% chlorhexidine gluconate were negative, but prick testing to 0.5% solution of the same agent revealed a positive reaction with a 5 x 5 mm wheal at the test site. Hypersensitivity testing to other antiseptics and surfactants used as well as to lidocaine, another constituent of the urethral gel, resulted negative. Testing to latex was also negative, both by open application test and by prick test. The patient was diagnosed with contact urticaria syndrome caused by hypersensitivity to chlorhexidine gluconate and was advised to avoid future exposures to the culprit agent. This case serves as a reminder of serious allergic reactions that may occur after exposure to chlorhexidine in the healthcare setting, especially during urological procedures where contact with mucosal sites likely increases the chance of a systemic reaction. It is also important to recognize that chlorhexidine may be present in various disinfectants for common use, such as mouthwashes and disinfectant wipes and hand gels, which may not have the active substance easily visible or declared on the product labelling. Lastly, it highlights the need to be vigilant regarding possible previous mild skin reactions after contact with disinfectants since it could lead to an increased risk for developing an anaphylactic reaction due to the multiple simultaneous exposures in the perioperative setting.

Chlorhexidine ; anaphylaxis ; Hypersensitivity

nije evidentirano