J Korean Med Sci.  2008 Jun;23(3):526-528. 10.3346/jkms.2008.23.3.526.

A Case of Anaphylaxis to Chlorhexidine during Digital Rectal Examination

• Bae YJ
• Park CS
• Lee JK
• Jeong E
• Kim TB
• Cho YS
• Moon HB

• KMID: 1786895
• DOI: http://doi.org/10.3346/jkms.2008.23.3.526

Abstract

Chlorhexidine is widely used as an antiseptic and disinfectant in medical and nonmedical environments. Although the sensitization rate seems to be low, its ubiquitous use raises the possibility of sensitization in many patients and medical care workers. We describe a patient with anaphylaxis during digital rectal examination with chlorhexidine jelly. Urticaria, angioedema, dyspnea, and hypotension developed within a few minutes of the rectal examination. The patient fully recovered after treatment with epinephrine and corticosteroids. Skin tests for chlorhexidine were undertaken 5 weeks later, showing positive prick and intradermal skin tests. Within 30 min of the skin test, the patient complained of febrile sensation, chest tightness, angioedema, and urticaria on the face and trunk. An enzyme allergosorbent test for latex was negative. We present this case to alert clinicians about hypersensitivity to chlorhexidine that could potentially be life-threatening. We suggest that chlorhexidine should be recognized as a causative agent of anaphylaxis during procedural interventions.

Keyword

Chlorhexidine; Anaphylaxis; Digital Rectal Examination

MeSH Terms

Administration, Topical
Adrenal Cortex Hormones/administration & dosage
Anaphylaxis/*chemically induced/drug therapy
Anti-Infective Agents, Local/administration & dosage/*adverse effects
Chlorhexidine/administration & dosage/*adverse effects
*Digital Rectal Examination
Epinephrine/administration & dosage
Humans
Male
Middle Aged
Sympathomimetics/administration & dosage

Figure

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  Fig. 1 Skin prick (A) and intradermal test (B) with 5% chlorhexidine. A dilution of 1:100 chlorhexidine was weakly positive, and both dilution of 1:10 and 1:1 were strongly positive. a, a', positive control (histamine); b, b', negative control (saline); c, c', chlorhexidine 1:100 dilution; d, d', chlorhexidine 1:10 dilution; e, e', chlorhexidine 1:1 dilution.

• 

  Fig. 2 Facial swelling and skin rash after chlorhexidine skin test. Thirty minutes after the chlorhexidine skin prick and intradermal tests, the patient complained of febrile sensation, facial swelling and pruritic skin rash.

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