From the Guidelines
Chlorhexidine allergies should be taken seriously as they can range from mild skin irritation to life-threatening anaphylaxis, and immediate discontinuation of its use is recommended if an allergy is suspected. If you suspect a chlorhexidine allergy, seek alternative antiseptics such as povidone-iodine, alcohol-based products, or benzalkonium chloride. For patients with confirmed chlorhexidine allergies, it's essential to document this in medical records and wear a medical alert bracelet, as noted in a safety guideline for skin antisepsis for central neuraxial blockade 1.
True allergic reactions to chlorhexidine involve an immune system response, typically IgE-mediated, and can manifest as:
- Contact dermatitis
- Urticaria
- Respiratory symptoms
- Anaphylaxis The risk increases with repeated exposure, particularly when chlorhexidine is used on mucous membranes or broken skin, as reported in a study on suspected anaphylactic reactions associated with anaesthesia 1.
If you experience symptoms after chlorhexidine exposure, treat mild reactions with antihistamines and topical steroids, but seek immediate emergency care for severe reactions including difficulty breathing or swelling. Allergy testing by an allergist can confirm the diagnosis and help identify safe alternatives for future use. It is also prudent to allow skin disinfectant to completely dry before beginning an invasive procedure, as suggested in the study on suspected anaphylactic reactions associated with anaesthesia 1.
From the FDA Drug Label
Warnings For external use only Allergy alert This product may cause a severe allergic reaction. Symptoms may include: wheezing/difficulty breathing shock facial swelling hives rash Do not use if you are allergic to chlorhexidine gluconate or any other ingredient in this preparation Stop use and ask a doctor if irritation, sensitization, or allergic reaction occurs and lasts for 72 hours.
Chlorhexidine allergy is a recognized concern with the use of chlorhexidine products.
- Symptoms of an allergic reaction may include:
- Wheezing or difficulty breathing
- Shock
- Facial swelling
- Hives
- Rash If an allergic reaction is suspected, stop use and seek medical help right away 2.
From the Research
Chlorhexidine Allergy Overview
- Chlorhexidine is a synthetic bisbiguanide antiseptic that has been used in healthcare since 1954 3
- Allergy to chlorhexidine has been increasingly reported, particularly in perioperative and medical procedural settings 3
- Hypersensitivity reactions to chlorhexidine can range from mild cutaneous reactions to anaphylaxis or death 3, 4
Clinical Manifestations
- Symptoms of chlorhexidine allergy can include mild skin symptoms to life-threatening anaphylaxis 5
- Allergic contact dermatitis can precede anaphylaxis in some cases 6
- Immediate hypersensitivity reactions to chlorhexidine can cause both skin and respiratory symptoms 7
Diagnostic Methods and Management
- Testing for chlorhexidine allergy is based on skin testing and in vitro testing 5
- Skin prick testing and specific IgE have high sensitivities and specificities for diagnosing chlorhexidine allergy 5
- Preventative initiatives can minimize the risk of both chlorhexidine sensitization and allergy development, as well as accidental re-exposure in patients with chlorhexidine allergy 5
Prevention and Awareness
- It is essential for physicians to be aware of the many possible sources of contact with chlorhexidine and to recognize the potentially debilitating and catastrophic reactions that may occur due to chlorhexidine sensitization 6
- The use of chlorhexidine at a 0.05% concentration on wounds and intact skin was previously thought to be safe, but the potential risk of anaphylactic reactions due to the application of chlorhexidine is well known 4