Repeated Anaphylaxis due to Chlorhexidine Skin Application during Urological Operations: A Case Report

Chlorhexidine皮膚消毒液造成病人在泌尿科手術中多次過敏一病例報告

葉力仁(Li-Jen Yeh) ； 施勳彰(Hsun-Chang Shih) ； 林聖瀚(Sheng-Han Lin) ； 盧正淵(Cheng-Yuan Lu)

《北市醫學雜誌》 10卷4期 (2013/12) Pp. 374-379

https://doi.org/10.6200/TCMJ.2013.10.4.10

摘要

Chlorhexidine今日在手術房逐漸被廣泛用作抗菌劑及消毒液。對chlorhexidine過敏是很少的，而因chlorhexidine用作皮膚消毒液，所引起過敏的案例更是少見。一名53歲的男性病人，於三次不同的泌尿科手術中，分別接受全身麻醉、半身麻醉以及靜脈麻醉，發生三次原因不明的休克現象。這位病人手術部位的皮膚是用Chlorhexidine消毒液消毒的。後來病人血清中chlorhexidine的特異IgE呈現陽性反應，同時也排除了其他可疑的藥物及藥劑。我們必須知道chlorhexidine是可以引起過敏的，即使只是用在皮膚消毒，本文的探討是可以減低病人對藥物副作用的風險。

關鍵字

過敏 ； 麻醉 ； 泌尿科手術 ； 克羅赫絲錠 ； 消毒劑

並列摘要

Chlorhexidine is an antiseptics and disinfectant for operating rooms. Anaphylaxis to chlorhexidine is rare, and anaphylaxis to chlorhexidine due to skin application is even rarer. A 53-year-old male patient had three unexplained anaphylactic shock episodes during three consecutive, individual, urological operations under general anesthesia, spinal anesthesia and intravenous general anesthesia, respectively. Chlorhexidine was used as a skin disinfectant for this patient. Later, serum chlorhexidine specific IgE revealed positive result, with suspected drugs and chemicals ruled out. Health care workers should be aware of a potential allergen property of chlorhexidine even when applied on skin.

並列關鍵字

anaphylaxis ； anesthesia ； urologic surgery ； chlorhexidine ； disinfectant

參考文獻

Guleri A, Kumar A, Morgan RJ, Hartley M, Roberts DH. Anaphylaxis to chlorhexidinecoated central venous catheters: a case series and review of the literature. Surg Infect 2012; 13(3):171-4.

P a r k e s AW, H a r p e r N , H e r w a d k a r A , Pumphrey R. Anaphylaxis to the chlorhexidine component of Instillagel: a case series. Br J Anaesth 2009; 102(1):65-8.

Jayathillake A, Mason DF, Broome K. Allergy to chlorhexidine gluconate in urethral gel: report of four cases and review of the literature. Urology 2003; 61(4):837.

Jee R, Nel L, Gnanakumaran G, Williams A, Eren E. Four cases of anaphylaxis to chlorhexidine impregnated central venous catheters: a case cluster or the tip of the iceberg? Br J Anaesth 2009; 103(4):614-5.

Ebo DG, Fisher MM, Hagendorens MM, Bridts CH, Stevens WJ. Anaphylaxis during anaesthesia: diagnostic approach. Allergy 2007; 62(5):471-87.