Clin Endosc.  2020 Nov;53(6):743-745. 10.5946/ce.2019.129.

A Case of Suspicious Allergic Reaction to Peracetic Acid Following Endoscopy

• Harada N
• Hirowatari M
• Ihara E
• Ishihara E
• Inoue M
• Miyamura T
• Nakamuta M

• KMID: 2511235
• DOI: http://doi.org/10.5946/ce.2019.129

Abstract

A 43-year-old man with rheumatic arthritis was admitted to our hospital for symptoms of cough, left chest pain, and left elbow pain, and further examination revealed an elevated level of C-reactive protein. On day 2 after admission, he underwent esophagogastroduodenoscopy. On the morning of day 7, he developed a high fever of 39.7°C, several hours after bronchoscopy. On day 13, he underwent colonoscopy. Five minutes after the colonoscopy, he developed a high fever of 39.9°C, accompanied by stridor, indicating a decrease in arterial oxygen saturation level. An intradermal test for peracetic acid which was used for cleaning flexible endoscopy was positive. We suspect that he suffered from an allergic reaction to peracetic acid following the flexible endoscopy. This is the first case reported on suspicious allergic reaction to peracetic acid following a flexible endoscopy procedure.

Keyword

Allergy; Asthma; Disinfectant; Endoscopy; Peracetic acid

Reference

1. ASGE Quality Assurance in Endoscopy Committee, Calderwood AH, Day LW, et al. ASGE guideline for infection control during GI endoscopy. Gastrointest Endosc. 2018; 87:1167–1179.

2. Murdani A, Kumar A, Chiu HM, et al. WEO position statement on hygiene in digestive endoscopy: focus on endoscopy units in Asia and the Middle East. Dig Endosc. 2017; 29:3–15.

3. Akamatsu T, Ishihara R, Sato T, et al. [Multi-society practice guide for reprocessing procedures of gastrointestinal endoscope]. Gastroenterological Endoscopy. 2014; 56:89–107.

4. Calder IM, Wright LP, Grimstone D. Glutaraldehyde allergy in endoscopy units. Lancet. 1992; 339:433.

5. Corrado OJ, Osman J, Davies RJ. Asthma and rhinitis after exposure to glutaraldehyde in endoscopy units. Hum Toxicol. 1986; 5:325–328.

6. Sokol WN. Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy. J Allergy Clin Immunol. 2004; 114:392–397.

7. Suzukawa M, Yamaguchi M, Komiya A, Kimura M, Nito T, Yamamoto K. Ortho-phthalaldehyde-induced anaphylaxis after laryngoscopy. J Allergy Clin Immunol. 2006; 117:1500–1501.

8. Cristofari-Marquand E, Kacel M, Milhe F, Magnan A, Lehucher-Michel MP. Asthma caused by peracetic acid-hydrogen peroxide mixture. J Occup Health. 2007; 49:155–158.

9. Tonini S, Dellabianca A, Costa C, Lanfranco A, Scafa F, Candura SM. Irritant vocal cord dysfunction and occupational bronchial asthma: differential diagnosis in a health care worker. Int J Occup Med Environ Health. 2009; 22:401–406.

10. Gutterman E, Jorgensen L, Mitchell A, Fua S. Adverse staff health outcomes associated with endoscope reprocessing. Biomed Instrum Technol. 2013; 47:172–179.