Anaphylaxis after disinfection with 2% chlorhexidine wand applicator

Area of Science:

• Anesthesiology
• Nephrology
• Allergy and Immunology

Background:

• Patients undergoing hemodialysis require vascular access, often via a central venous catheter.
• Skin preparation with antiseptics like chlorhexidine is standard before invasive procedures to prevent infection.
• End-stage renal failure necessitates regular dialysis treatments, increasing exposure to medical procedures and agents.

Observation:

• A 54-year-old man developed immediate, severe symptoms including pruritus, urticaria, shortness of breath, hypotension, and reduced responsiveness upon application of 2% chlorhexidine.
• These symptoms were consistent with anaphylaxis, a life-threatening allergic reaction.
• The patient was undergoing dialysis for end-stage renal failure and a Tesio catheter was being inserted.

Findings:

• The patient's symptoms rapidly improved following treatment for anaphylaxis.
• Skin testing confirmed a specific allergy to chlorhexidine.
• Subsequent dialysis procedures were performed without complication after avoiding chlorhexidine.

Implications:

• This case underscores the potential for severe chlorhexidine allergy in patients, even those with chronic conditions requiring frequent medical interventions.
• Healthcare providers must be vigilant for allergic reactions to chlorhexidine, especially during invasive procedures.
• Alternative antiseptic agents should be considered for patients with a known or suspected chlorhexidine allergy to ensure procedural safety.