Department of Anaesthesia, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
Department of Immunology, Manchester University NHS Foundation Trust, Manchester, UK.
Br J Anaesth. 2019 Jul;123(1):e95-e103. doi: 10.1016/j.bja.2019.01.033. Epub 2019 Apr 5.
Chlorhexidine is an antiseptic with a broad spectrum of activity and a persistent effect on skin. Consequently, it has become an ubiquitous antiseptic in healthcare and the community. As use has become widespread, increasing numbers of cases of allergy have been reported in the literature, including cases of anaphylaxis to chlorhexidine gels used on mucous membranes, chlorhexidine-impregnated devices such as central venous catheters, chlorhexidine preparations used on wounds and broken skin, and cases after dental procedures. Numerous governmental warnings have been issued over recent decades to warn of the risk of allergy to chlorhexidine on mucosal surfaces or in medical devices. Whilst the number of published cases likely underestimates the true prevalence of reactions, we retrospectively surveyed clinics with experience in investigating perioperative chlorhexidine allergy. Despite differences in investigation practice before the survey took place, 13 clinics responded which together had diagnosed 252 cases of anaphylaxis to chlorhexidine, and cases of delayed allergy. In eight of 13 clinics, chlorhexidine was within the top four most commonly diagnosed causes of perioperative anaphylaxis. Despite this, the incidence of anaphylaxis to chlorhexidine is low given that patients are very commonly exposed. Sensitisation of healthcare workers can occur, but is uncommon. Before exposing patients to this antiseptic, consideration of the potential risk vs benefit should be undertaken, particularly for higher risk exposures, such as mucosal exposure or i.v. exposure via impregnated lines. Difficulties exist in protecting patients with known allergies from re-exposure to chlorhexidine, which would be improved with uniform labelling and chlorhexidine product registers.
洗必泰是一种具有广谱活性和持久皮肤效果的防腐剂。因此，它已成为医疗保健和社区中无处不在的防腐剂。随着使用的广泛普及，文献中越来越多的过敏病例被报道，包括对粘膜用洗必泰凝胶、中央静脉导管等洗必泰浸渍设备、用于伤口和破皮的洗必泰制剂以及牙科手术后发生的过敏病例。近几十年来，发布了许多政府警告，以警告粘膜表面或医疗器械中洗必泰过敏的风险。尽管已发表的病例数可能低估了反应的真实流行率，但我们回顾性调查了具有调查围手术期洗必泰过敏经验的诊所。尽管在调查前的调查实践存在差异，但有 13 家诊所做出了回应，这些诊所共诊断出 252 例对洗必泰的过敏反应，包括迟发性过敏反应。在 13 家诊所中的 8 家，洗必泰是围手术期最常见的过敏原因的前四名之一。尽管如此，鉴于患者非常常见地暴露于洗必泰，洗必泰过敏的发生率仍然很低。医护人员可能会致敏，但并不常见。在将患者暴露于这种防腐剂之前，应考虑潜在的风险与收益，特别是对于粘膜暴露或通过浸渍线进行静脉暴露等更高风险的暴露。对于已知对洗必泰过敏的患者，存在难以避免再次暴露的问题，如果采用统一的标签和洗必泰产品登记制度，这个问题将得到改善。
