Allergic contact dermatitis to chlorhexidine in children
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Keywords
children, chlorhexidine, contact dermatitis, hypersensitivity, patch test, repeated open application test
Abstract
Background: Hypersensitivity to chlorhexidine is rare in children. The usefulness of different diagnostic tests for allergic contact dermatitis (ACD) is unknown.
Objective: We aim to describe a case series of children with hypersensitivity to chlorhexidine and to compare the results of different diagnostic tests.
Patients: Nine children with hypersensitivity to chlorhexidine were included. Only six of these children and their parents consented to a comprehensive allergy assessment, which included the prick test, intradermal test, patch test, and repeated open application test (ROAT).
Results: Seven children (78%) presented symptoms of chlorhexidine hypersensitivity within the first 5 years of life; two of them before the age of 1 year. In four children, the dermatitis lesions were suggestive of wound superinfection. All six children who participated in the comprehensive diagnostic evaluation had negative results on the prick test. The immediate-reading intradermal test was positive in one case and uncertain in two cases. The patch test was positive in five cases, and the ROAT was positive in all six cases when using 2% chlorhexidine alcohol solution.
Conclusion: ACD to chlorhexidine in children appears to be rare and can be difficult to detect. Clinicians should consider this diagnosis when wounds worsen with chlorhexidine. Although the patch test is the most standardized method for detecting ACD, the ROAT with 2% chlorhexidine alcohol solution was the most sensitive test in our patients.
References
2 Opstrup MS, Johansen JD, Bossi R, Lundov MD, Garvey LH. Chlorhexidine in cosmetic products–a market survey. Contact Dermatitis. 2015;72(1):55–8. 10.1111/cod.12645
3 Opstrup MS, Johansen JD, Garvey LH. Chlorhexidine allergy: sources of exposure in the health-care setting. Br J Anaesth. 2015;114(4):704–5. 10.1093/bja/aev050
4 Calnan CD. Contact dermatitis from drugs. J R Soc Med. 1962;55(1):39–42. 10.1177/003591576205500111
5 Birdwood G. Reaction to chlorhexidine and cetrimide. Lancet. 1965;1(7386):651–652. 10.1016/S0140-6736(65)91742-3
6 Scheman A, Patel KR, Roszko K, Severson D, Brod B, Jacob SE, et al. Relative prevalence of contact allergens in North America in 2018. Dermatitis. 2020;31(2):112–21. 10.1097/DER.0000000000000521
7 Opstrup MS, Johansen JD, Zachariae C, Garvey LH. Contact allergy to chlorhexidine in a tertiary dermatology clinic in Denmark. Contact Dermatitis. 2016;74(1):29–36. 10.1111/cod.12487
8 Calado R, Calvão da Silva J, Gomes T, Gonçalo M. Is there a place for chlorhexidine in the European baseline series? Contact Dermatitis. 2021;85(3):372–3. 10.1111/cod.13861
9 Warshaw EM, Han J, Kullberg SA, DeKoven JG, Adler BL, Silverberg JI, et al. Patch testing to chlorhexidine digluconate, 1% aqueous: North American Contact Dermatitis Group experience, 2015-2020. Dermatitis. 2023;34(6):501–8. 10.1089/derm.2023.0077
10 Villa-Gonzalez JM, Gonzalez-Hermosa MR, Gardeazabal García J, Aramburu González A, Orbea Sopeña A, Pascual Ares M, et al. When the cure becomes worse than the disease: a case series of children with allergic contact dermatitis from chlorhexidine. J Eur Acad Dermatology Venereol. 2023;37(7):e936–8. 10.1111/jdv.19034
11 Magdaleno-Tapial J, Martínez-Doménech A, Valenzuela-Oñate C, Ferrer-Guillén B, Esteve-Martínez A, Zaragoza-Ninet V. Allergic contact dermatitis to chlorhexidine in pediatric patients. Pediatr Dermatol. 2019;36(4):540–1. 10.1111/pde.13808
12 Evangelista V, Vincenzi C, Bruni F, Piraccini BM, Neri I. Contact dermatitis apparently triggered by meningococcal and polyvalent vaccines: a case of allergic contact dermatitis due to chlorhexidine. Contact Dermatitis. 2021;85(3):354–5. 10.1111/cod.13846
13 Galadari A, Darrigade AS, Boralevi F, Milpied B. A child polysensitized to all constituents of Biseptine. Contact Dermatitis. 2020;82(1):65–6. 10.1111/cod.13393
14 Le Corre Y, Barbarot S, Frot AS, Milpied B. Allergic contact dermatitis to chlorhexidine in a very young child. Pediatr Dermatol. 2010;27(5):485–7. 10.1111/j.1525-1470.2010.01257.x
15 De Waard-Van Der Spek FB, Oranje AP. Allergic contact dermatitis to chlorhexidine and para-amino compounds in a 4-year-old boy: A very rare observation. Contact Dermatitis. 2008;58(4):239–41. 10.1111/j.1600-0536.2007.01256.x
16 Córdoba S, Sanz-Sánchez T, Mohedano-Vicente E, Borbujo J. Allergic contact dermatitis due to chlorhexidine in 2 pediatric patient. Actas Dermo-Sifiliográficas. 2019;110(1):76–7. 10.1016/j.ad.2017.10.018
17 Kefala K, Ponvert C. Allergic contact dermatitis to chlorhexidine-containing antiseptics and their excipients in children: a series of six cases. Pediatr Dermatol. 2023;40(1):151–3. 10.1111/pde.15127
18 Labrandero Hoyos C, Grau Echevarría A, Peñuelas Leal R, Spröhnle JL, Imbernon DB, Finello M, et al. Immediate and delayed hypersensitivity to chlorhexidine coexisting in the same patient. Contact Dermatitis. 2024;90(3):320–2. 10.1111/cod.14480
19 Opstrup MS, Jemec GBE, Garvey LH. Chlorhexidine allergy: on the rise and often overlooked. Curr Allergy Asthma Rep. 2019;19(5):23. 10.1007/s11882-019-0858-2
20 Wanin S, Baron M, Carra S, Saf S, Bourgoin-Heck M, Chiriac AM. Chlorhexidine anaphylaxis in three children secondary to oral exposure without evidence of mucosal breach. Pediatr Allergy Immunol. 2022;33(12):1–3. 10.1111/pai.13897
21 Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher A, Bruze M, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing–recommendations on best practice. Contact Dermatitis. 2015;73(4):195–221. 10.1111/cod.12432
22 Beaumont C, Darrigade AS, Barbaud A, Collet E, Raison-Peyron N, Bourrain JL, et al. Multiple cases of sensitization to an antiseptic containing chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol with different profiles of sensitization in adults and children. Contact Dermatitis. 2022;87(1):62–70. 10.1111/cod.14085
23 Mailhol C, Lauwers-Cances V, Rancé F, Paul C, Giordano-Labadie F. Prevalence and risk factors for allergic contact dermatitis to topical treatment in atopic dermatitis: a study in 641 children. Allergy. 2009;64(5):801–6. 10.1111/j.1398-9995.2008.01890.x
24 Darrigade AS, Léauté-Labrèze C, Boralevi F, Taïeb A, Milpied B. Allergic contact reaction to antiseptics in very young children. J Eur Acad Dermatology Venereol. 2018;32(12):2284–7. 10.1111/jdv.15140
25 Tupker RA, Schuur J, Coenraads PJ. Irritancy of antiseptics tested by repeated open exposures on the human skin, evaluated by non-invasive methods. Contact Dermatitis. 1997; 37(5):213–7. 10.1111/j.1600-0536.1997.tb02437.x
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