IgE-mediated chlorhexidine allergy-Cross-reactivity with other biguanide disinfectants.
IgE
ImmunoCAP
alexidine
allergy
anaphylaxis
basophil activation test
biguanide disinfectants
chlorhexidine
cross-reactivity
octenidine
polyhexanide
Journal
Allergy
ISSN: 1398-9995
Titre abrégé: Allergy
Pays: Denmark
ID NLM: 7804028
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
27
03
2020
revised:
30
04
2020
accepted:
05
05
2020
pubmed:
18
7
2020
medline:
15
5
2021
entrez:
18
7
2020
Statut:
ppublish
Résumé
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 reacted primarily with OCT and showed IgE cross-reactivity with CHX, ALX, and PHMB. The IgE response to CHX seems polyclonal. The chloroguanide ending of CHX is the main epitope for the IgE and is suitable as screening assay to detect CHX reactivity. IgE-reactivities with the biguanide or hexamethylene components of other disinfectants (ALX, PHMB) can be detected by SPT, PHMB ImmunoCAP, and ALX-BAT in 15%-33% of CHX-allergic patients.
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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 reacted primarily with OCT and showed IgE cross-reactivity with CHX, ALX, and PHMB.
CONCLUSION
The IgE response to CHX seems polyclonal. The chloroguanide ending of CHX is the main epitope for the IgE and is suitable as screening assay to detect CHX reactivity. IgE-reactivities with the biguanide or hexamethylene components of other disinfectants (ALX, PHMB) can be detected by SPT, PHMB ImmunoCAP, and ALX-BAT in 15%-33% of CHX-allergic patients.
Substances chimiques
Biguanides
0
Disinfectants
0
Immunoglobulin E
37341-29-0
Chlorhexidine
R4KO0DY52L
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3237-3247Informations de copyright
© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
Références
Calogiuri GF, Di Leo E, Trautmann A, et al. Chlorhexidine hypersensitivity: a critical and updated review. J Allergy Ther. 2013;4:141.
Garvey LH, Roed-Petersen J, Husum B. Anaphylactic reactions in anaesthetised patients - four cases of chlorhexidine allergy. Acta Anaesthesiol Scand. 2001;45:1290-1294.
Wicki J, Deluze C, Cirafici L, Desmeules J. Anaphylactic shock induced by intraurethral use of chlorhexidine. Allergy. 1999;54(7):768-769.
Ljunggren B, Möller H. Eczematous contact allergy to chlorhexidine. Acta Derm Venereol. 1972;52(4):308-310.
Opstrup MS, Johansen JD, Garvey LH. Chlorhexidine allergy: sources of exposure in the health-care setting. Br J Anaesth. 2015;114(4):704-705.
Ebo DG, Van Gasse AL, Decuyper II, et al. Acute management, diagnosis, and follow-up of suspected perioperative hypersensitivity reactions in Flanders 2001-2018. J Allergy Clin Immunol Pract. 2019;7(7):2194-2204.e7.
Layton GT, Stanworth DR, Amos HE. The incidence of IgE and IgG antibodies to chlorhexidine. Clin Exp Allergy. 1989;19:307-314.
Nagendran V, Wicking J, Ekbote A, Onyekwe T, Garvey L. IgE-mediated chlorhexidine allergy: a new occupational hazard? Occup Med. 2009;59(4):270-272.
Pham NH, Weiner JM, Reisner GS, Baldo BA. Anaphylaxis to chlorhexidine. Case report. Implication of immunoglobulin E antibodies and identification of an allergenic determinant. Clin Exp Allergy. 2000;30(7):1001-1007.
Schrøder MA, Kirketerp-Møller K, Winther L. Suspected anaphylaxis by wound treatment with polyhexanide derivate wound products. Ugeskr Laeger. 2014;176(25A):V02120094.
Schunter JA, Stöcker B, Brehler R. A case of severe anaphylaxis to polyhexanide: cross-reactivity between biguanide antiseptics. Int Arch Allergy Immunol. 2017;173(4):233-236.
Kautz O, Schumann H, Degerbeck F, Venemalm L, Jakob T. Severe anaphylaxis to the antiseptic polyhexanide. Allergy. 2010;65(8):1068-1070.
Olivieri J, Eigenmann PA, Hauser C. Severe anaphylaxis to a new disinfectant: polyhexanide, a chlorhexidine polymer. Schweiz Med Wochenschr. 1998;128(40):1508-1511.
Calow T, Oberle K, Bruckner-Tuderman L, Jakob T, Schumann H. Contact dermatitis due to use of Octenisept in wound care. J Dtsch Dermatol Ges. 2009;7(9):759-765.
Bubenhofer M, Fricker M, Weber-Mani U, Helbling A. Chlorhexidine: a retrospective observational study of a potentially life-threatening molecule. J Investig Allergol Clin Immunol. 2015;25(2):152-154.
Garvey LH, Krøigaard M, Poulsen LK, et al. IgE-mediated allergy to chlorhexidine. J Allergy Clin Immunol. 2007;120(2):409-415.
Bischoff SC, de Weck AL, Dahinden CA. Interleukin 3 andgranulocyte/macrophage-colony-stimulating factor render human basophilsresponsive to low concentrations of complement component C3a. Proc Natl Acad Sci USA. 1990;87(17):6813-6817.
Steiner UC, Gentinetta T, Hausmann O, Pichler WJ. IgE-mediated anaphylaxis to intraarticular glucocorticoid. Am J Roentgenol. 2009;193(2):W156-W157.
Pruzansky JJ, Grammer LC, Patterson R, Roberts M. Dissociation of IgE from receptors on human basophils. I. Enhanced passive sensitization for histamine release. J Immunol. 1983;131:1949-1953.
Yasui K, Matsuyama N, Okamura-Shiki I, et al. Clinical utility of a passive immune basophil activation test for the analysis of allergic transfusion reactions. Transfusion. 2017;57(9):2084-2095.
Van der Poorten MM, Van Gasse AL, Hagendorens MM, et al. Serum specific IgE antibodies in immediate drug hypersensitivity. Clin Chim Acta. 2020;504:119-124.
Ebo DG, Bridts CH, Mertens CH, Hagendorens MM, Stevens WJ, De Clerck LS. Analyzing histamine release by flow cytometry (HistaFlow): a novel instrument to study the degranulation patterns of basophils. J Immunol Methods. 2012;375(1-2):30-38.
Spoerl D, Jandus P, Harr T. Pitfalls and peculiarities in chlorhexidine allergy. J Allergy Clin Immunol Pract. 2016;5:991-992.