Standardized testing with chlorhexidine in perioperative allergy--a large single-centre evaluation

Area of Science:

• Anesthesiology
• Allergy Immunology
• Clinical Diagnostics

Background:

• Perioperative allergic reactions to chlorhexidine are severe but often overlooked.
• The prevalence of chlorhexidine allergy remains unknown, hindering diagnosis.
• Validated diagnostic models and test evaluations are lacking.

Purpose of the Study:

• To estimate the prevalence of chlorhexidine allergy in patients with perioperative allergic reactions.
• To evaluate the diagnostic accuracy (sensitivity and specificity) of various tests for chlorhexidine allergy.

Main Methods:

• A cohort of patients investigated for perioperative allergic reactions (2004-2012) was analyzed.
• Tests included specific IgE, histamine release (HR), skin prick test (SPT), and intradermal test (IDT).
• Chlorhexidine allergy was defined by clinical reaction plus ≥2 positive tests; diagnostic accuracy was calculated.

Main Results:

• 9.6% of patients (22/228) met the criteria for chlorhexidine allergy.
• Specific IgE demonstrated 100% sensitivity and 97% specificity.
• Skin prick test (SPT) showed 95% sensitivity and 97% specificity.

Conclusions:

• Chlorhexidine allergy was diagnosed in 9.6% of patients investigated for perioperative allergic reactions.
• Specific IgE and SPT offered the highest combined sensitivity and specificity for diagnosing chlorhexidine allergy.
• These findings aid in the diagnosis and management of perioperative hypersensitivity to chlorhexidine.