National Allergy Research Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark; Allergy Clinic, Danish Anaesthesia Allergy Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
Allergy. 2014 Oct;69(10):1390-6. doi: 10.1111/all.12466. Epub 2014 Aug 13.
Perioperative allergic reactions to chlorhexidine are often severe and easily overlooked. Although rare, the prevalence remains unknown. Correct diagnosis is crucial, but no validated provocation model exists, and other diagnostic tests have never been evaluated. The aims were to estimate (i) the prevalence of chlorhexidine allergy in perioperative allergy and (ii) the specificity and sensitivity for diagnostic tests for chlorhexidine allergy.
We included all patients investigated for suspected perioperative allergic reactions in the Danish Anaesthesia Allergy Centre during 2004-2012. The following tests were performed: specific IgE (Immunocap® ; Phadia AB, Sweden), histamine release test (HR) (RefLab ApS, Denmark), skin prick test (SPT) and intradermal test (IDT). Positivity criteria were as follows: specific IgE >0.35 kUA/l; HR class 1-12; SPT mean wheal diameter ≥3 mm; IDT mean wheal diameter ≥ twice the diameter of negative control. Chlorhexidine allergy was post hoc defined as a relevant clinical reaction to chlorhexidine combined with two or more positive tests. Based on this definition, sensitivity and specificity were estimated for each test.
In total, 22 of 228 patients (9.6%) met the definition of allergy to chlorhexidine. Estimated sensitivity and specificity were as follows: specific IgE (sensitivity 100% and specificity 97%), HR (sensitivity 55% and specificity 99%), SPT (sensitivity 95% and specificity 97%) and IDT (sensitivity 68% and specificity 100%).
In patients investigated for suspected perioperative allergic reactions, 9.6% were diagnosed with allergy to chlorhexidine. Using our definition of chlorhexidine allergy, the highest combined estimated sensitivity and specificity was found for specific IgE and SPT.
围手术期对洗必泰的过敏反应通常很严重且容易被忽视。尽管很少见，但发病率尚不清楚。正确的诊断至关重要，但目前尚无经过验证的激发模型，且其他诊断测试从未得到过评估。本研究的目的是评估（i）丹麦麻醉过敏中心 2004 年至 2012 年期间疑似围手术期过敏反应患者中洗必泰过敏的发生率，以及（ii）洗必泰过敏诊断测试的特异性和敏感性。
我们纳入了丹麦麻醉过敏中心在 2004 年至 2012 年期间调查的所有疑似围手术期过敏反应患者。进行了以下测试：特异性 IgE（Immunocap®；Phadia AB，瑞典）、组胺释放试验（HR）（RefLab ApS，丹麦）、皮肤点刺试验（SPT）和皮内试验（IDT）。阳性标准如下：特异性 IgE >0.35 kUA/l；HR 分级 1-12 级；SPT 平均风团直径≥3mm；IDT 平均风团直径是阴性对照的两倍。根据该定义，将洗必泰过敏定义为与洗必泰相关的临床过敏反应，同时伴有两项或更多阳性测试。基于此定义，估计了每种测试的敏感性和特异性。
共有 228 例患者中的 22 例（9.6%）符合洗必泰过敏的定义。估计的敏感性和特异性如下：特异性 IgE（敏感性 100%，特异性 97%）、HR（敏感性 55%，特异性 99%）、SPT（敏感性 95%，特异性 97%）和 IDT（敏感性 68%，特异性 100%）。
在疑似围手术期过敏反应的患者中，9.6%被诊断为洗必泰过敏。根据我们的洗必泰过敏定义，特异性 IgE 和 SPT 的联合估计敏感性和特异性最高。
