IgE-mediated chlorhexidine allergy-Cross-reactivity with other biguanide disinfectants.

Allergy
Nicole Mueller-WirthWerner J Pichler

Abstract

Chlorhexidine (CHX) is a widely utilized disinfectant that can cause IgE-mediated urticaria/anaphylaxis. The cross-reactivity of patients with IgE-mediated CHX allergy with other disinfectants, which share structural similarities with CHX like polyhexanide (polyhexamethylene biguanide; PHMB), alexidine (ALX), or octenidine (OCT), is unknown. Forty-four patients with anaphylaxis or urticaria upon CHX exposure and positive skin prick test (SPT) and/or positive CHX ImmunoCAP test (Phadia TFS, Uppsala, Sweden) were recruited. IgE to the biguanide and/or hexamethylene structure was investigated with PHMB ImmunoCAP (n = 32) and by basophil activation tests (BAT) with CHX and ALX (n = 37). Inhibition tests of CHX and PHMB ImmunoCAPs by CHX, ALX, PHMB, and OCT were performed. IgE reactivity to PHMB as surrogate marker for biguanide/hexamethylene reactivity was detected in 5/32 sera. Seven of 37 patients showed a positive BAT with ALX, but only under optimized conditions. Binding to CHX ImmunoCAP was inhibited by ALX in 1/32 sera, and binding to PHMB was blocked by ALX (1/5) and by OCT in another (1/5). In SPT, 9/10 patients were positive for CHX and 3 of them with ALX (only at highest concentration at 5 mg/mL). A further patient reacte...Continue Reading

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Citations

Feb 5, 2021·Cytometry. Part B, Clinical Cytometry·Theodore KimSøren Ulrik Sønder
Nov 6, 2020·The Journal of Allergy and Clinical Immunology·Didier G EboVito Sabato
Jun 29, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Jessy ElstDidier G Ebo
Jul 8, 2021·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·Jessy ElstDidier G Ebo

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