Published: 6 June 2013

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Chlorhexidine - Risk of Anaphylaxis

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Prescriber Update 34(2):22
June 2013

Severe allergic reactions including anaphylaxis have been reported following use of chlorhexidine.

The Centre for Adverse Reaction Monitoring (CARM) has received eight reports of anaphylactic reactions to chlorhexidine and lignocaine combination products in men undergoing urinary catheterisation. The patient’s age ranged from 22 to 79 years.

Of the eight cases, five reported the results of a skin prick test of which four were positive for chlorhexidine sensitivity.

In addition to the above cases, CARM have received 61 reports of anaphylactic reactions to medicines containing chlorhexidine since 2000. Of the 61 reports, 55 occurred in males and six in females.

A number of medicines, including over-the-counter products, contain chlorhexidine including antiseptic creams/gels, dressings, mouthwashes, eye drops, throat sprays, contact lens solutions and nasal sprays. The ingredients of approved products can be checking using the product application search on the Medsafe website (www.medsafe.govt.nz/regulatory/DbSearch.asp).

In a recent case series on anaphylaxis attributed to chlorhexidine in lubricants used in urethral catheterisation, the variety and increasing use of chlorhexidine containing products was postulated to result in sensitisation to chlorhexidine¹. This could lead to an increase in life-threatening allergic reactions to chlorhexidine.

If healthcare professionals suspect a patient has an allergy to chlorhexidine, an alternative product should be used. Chlorhexidine-free products are approved in New Zealand for patients with an allergy to chlorhexidine.

Healthcare professionals are encouraged to report all anaphylactic reactions to products containing chlorhexidine to CARM. Reporting of these reactions is important as CARM can then record a warning on the National Alert System for that patient.

References

1. Parkes AW, Harper N, Herwadkar A, et al. 2009. Anaphylaxis to the chlorhexidine component of Instillagel: a case series. British Journal of Anaesthesia 102: 65–8.