Anaphylactic reaction to a chlorhexidine-coated central venous catheter

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We report a patient with a life-threatening anaphylactic reaction to a chlorhexidine-coated central venous catheter, confirmed with a high serum level of chlorhexidine-specific IgE” Wang et al (2016).

Abstract:

IMPORTANCE: We report a patient with a life-threatening anaphylactic reaction to a chlorhexidine-coated central venous catheter, confirmed with a high serum level of chlorhexidine-specific IgE. To our knowledge, this is the first case successfully resuscitated using extracorporeal membrane oxygenation (ECMO). Great caution is required when using chlorhexidine and chlorhexidine-impregnated catheters, given that its widespread use has the potential to sensitize certain patients and may result in life-threatening anaphylaxis on subsequent exposure.

OBSERVATIONS: A case report of a single patient with life-threatening anaphylactic shock to chlorhexidine, who was successfully resuscitated using ECMO.

CONCLUSIONS: We have designed a flowchart for the diagnosis and management of severe anaphylaxis. This case report highlights the potential for chlorhexidine to be a source for the development of refractory anaphylactic shock. We suggest that ECMO may save the lives of patients with severe bronchospasm and refractory anaphylactic shock secondary to chlorhexidine.

Reference:

Wang, M.L., Chang, C.T., Huang, H.H., Yeh, Y.C., Lee, T.S. and Hung, K.Y. (2016) Chlorhexidine-related refractory anaphylactic shock: a case successfully resuscitated with extracorporeal membrane oxygenation. Journal of Clinical Anesthesia. 34, p.654-7.

doi: 10.1016/j.jclinane.2016.07.002.

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