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Severe and near-fatal anaphylactic reactions triggered by chlorhexidine-coated catheters in patients undergoing renal allograft surgery: a case series

  • Alex Ho
  • Jeffrey Zaltzman
  • Gregory M. T. Hare
  • Lucy Chen
  • Lisa Fu
  • Susan M. Tarlo
  • Peter VadasEmail author
Case Reports / Case Series
  • 247 Downloads

Abstract

Purpose

Although intraoperative anaphylaxis during surgery is a rare event, we describe five patients who experienced perioperative anaphylactic reactions during renal transplantation and were referred for investigation.

Clinical features

Skin-prick and intradermal skin tests were done to investigate potential allergies to drugs given perioperatively prior to the development of anaphylaxis, including basiliximab, propofol, cefazolin, cis-atracurium, fentanyl, latex, remifentanil, and chlorhexidine. In addition, in vitro serologic testing for specific IgE was done in patients suspected to have had chlorhexidine anaphylaxis. All five patients were male, with a mean age of 48 yr (range 30–69). Skin testing for all drugs was non-reactive except for chlorhexidine, which was positive in four of five patients (one patient refused intradermal testing). In vitro test results for chlorhexidine-specific IgE were positive in all of the patients. Anesthetic records showed that intraoperative anaphylaxis had occurred immediately after insertion of a chlorhexidine-coated central venous catheter.

Conclusions

Intraoperative insertion of chlorhexidine-coated central venous catheters can trigger life-threatening anaphylaxis in susceptible patients undergoing renal transplantation.

Réactions anaphylactiques sévères et quasi fatales déclenchées par des cathéters enduits de chlorhexidine chez des patients subissant une chirurgie d’allogreffe rénale : une série de cas

Résumé

Objectif

Bien que l’anaphylaxie peropératoire pendant la chirurgie soit une complication rare, nous décrivons ici les cas de cinq patients ayant subi des réactions anaphylactiques périopératoires pendant une greffe rénale et qui ont été référés pour examens approfondis.

Éléments cliniques

Des tests par scarification et des tests intradermiques ont été réalisés afin d’évaluer les allergies potentielles aux médicaments administrés en période périopératoire avant l’apparition de l’anaphylaxie, notamment la sensibilité des patients au basiliximab, au propofol, à la céfazoline, au cisatracurium, au fentanyl, au latex, au rémifentanil et à la chlorhexidine. En outre, des tests sérologiques in vitro ont été réalisés pour l’immunoglobuline E (IgE) spécifique chez les patients soupçonnés d’avoir souffert d’un choc anaphylactique à la chlorhexidine. Les cinq patients étaient tous des hommes, d’un âge moyen de 48 ans (30 à 69 ans). Les tests dermiques étaient non réactifs pour tous les médicaments à l’exception de la chlorhexidine, pour laquelle le test s’est révélé positif chez quatre des cinq patients (un patient a refusé le test intradermique). Les résultats des tests in vitro pour l’IgE spécifique à la chlorhexidine étaient positifs chez tous les patients. Les dossiers anesthésiques ont montré que l’anaphylaxie peropératoire était survenue immédiatement après l’insertion d’un cathéter veineux central enduit de chlorhexidine.

Conclusion

L’insertion peropératoire de cathéters veineux centraux enduits de chlorhexidine peut déclencher une anaphylaxie potentiellement fatale chez les patients susceptibles subissant une greffe rénale.

Notes

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Alex Ho was involved in data acquisition and analysis, and study design. Lisa Fu was involved in the initial drafting of the manuscript. Jeffrey Zaltzman was involved in data collection. Lucy Chen was involved in data collection. Susan M. Tarlo contributed to manuscript preparation. Gregory M.T. Hare contributed to manuscript preparation. Peter Vadas was involved in data collection and analysis, study design, and preparation of the manuscript.

Funding

Self-funded.

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  • Alex Ho
    • 1
  • Jeffrey Zaltzman
    • 2
  • Gregory M. T. Hare
    • 1
  • Lucy Chen
    • 2
  • Lisa Fu
    • 3
  • Susan M. Tarlo
    • 4
  • Peter Vadas
    • 3
    Email author
  1. 1.Department of Anesthesia, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  2. 2.Division of Nephrology, Department of Medicine, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  3. 3.Division of Allergy and Clinical Immunology, Department of Medicine, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  4. 4.Division of Respirology, Department of Medicine, University Health NetworkUniversity of TorontoTorontoCanada

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