Abstract

Background:
Anaphylaxis is a severe life-threatening systemic hypersensitivity reaction. It is a clinical diagnosis based on widely accepted criteria and is characterized by its rapid onset in skin and mucosal changes and/or airway, breathing and circulatory problems. Careful history taking to identify the causing trigger is essential. Evidence of IgE-sensitization on skin prick test or in vitro testing confirms the diagnosis.
Case:
A 13-year old girl presented to the emergency department with a sudden anaphylactic event. Detailed medical history revealed that the event initiated immediately after eating her usual lunch consisting of cheese sandwiches, and a glass of cow’s milk and 20 minutes after using a topical disinfectant spray Mercurochrome®, containing chlorhexidine digluconate, on a wound on her right knee after a fall earlier that day. She rapidly developed a generalized urticarial rash, dyspnea, throat swelling and nausea. After an antihistamine was administered without sufficient improvement, she presented at the hospital. She had no particular medical history and no history of atopic diseases. Physical examination revealed normal blood pressure, normal oxygen saturation, mild respiratory distress, urticarial skin rash and swelling of her throat. Anaphylaxis was diagnosed. Adrenaline 0.01 mg/kg was injected intramuscular with immediate clinical improvement. Intravenous glucocorticosteroids were administered to treat the lasting cutaneous reaction.
Specific IgE-levels showed normal levels for wheat, milk, alpha-lactalbumin, beta-lactoglobulin, casein, cheese and omega-5 gliadin and a total IgE of 19.1 kU/L. Serum IgE-level of chlorhexidine was 4.0 kU/L, corresponding with a class 3 allergy. The diagnosis of a chlorhexidine allergy was confirmed.
Conclusion:
Anaphylaxis is a clinical emergency and all healthcare professionals should be familiar with its acute and ongoing management. A careful history to identify triggers is key.
Chlorhexidine is a widely used antiseptic and disinfectant. It is also used in many other products, including mouthwashes, eye drops and cosmetics. Delayed type IV allergic reactions such as contact dermatitis are most commonly observed. However, type I reactions such as anaphylaxis have been increasingly reported. Strict allergen avoidance and an anaphylaxis management plan with the use of adrenaline auto-injector and follow-up in an allergy clinic are essential.
Original languageEnglish
Publication statusUnpublished - 2021
Event49ste jaarlijkse congres van de BVK - online meeting, Belgium
Duration: 18 Mar 202119 Mar 2021

Conference

Conference49ste jaarlijkse congres van de BVK
CountryBelgium
Period18/03/2119/03/21

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