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JA Clinical Reports
Published in: JA Clinical Reports 1/2022

Open Access 01-12-2022 | Anaphylaxis | Case report

Intraoperative chlorhexidine-induced anaphylaxis suggesting an immunoglobulin-E-dependent mechanism indicated by basophil activation tests: two case reports

Authors: Masaki Orihara, Tomonori Takazawa, Tatsuo Horiuchi, Kazuhiro Nagumo, Noboru Maruyama, Akihiro Tomioka, Shigeru Saito

Published in: JA Clinical Reports | Issue 1/2022

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Abstract

Background

Although chlorhexidine allergy has been shown to be mediated by immunoglobulin (Ig) E, few reports investigated the mechanism of chlorhexidine-induced anaphylaxis using basophil activation tests (BATs).

Case presentation

A 79-year-old man underwent cholecystectomy under general anesthesia. Anaphylaxis was diagnosed based on the clinical symptoms and high serum tryptase and histamine levels. Skin tests showed positive results only for chlorhexidine. Subsequently, BATs demonstrated that the causative agent was likely chlorhexidine. The inhibitory effect of wortmannin, an inhibitor of phosphoinositide 3-kinase, on basophil activation suggested an IgE-dependent mechanism underlying chlorhexidine-induced anaphylaxis.
An 89-year-old man underwent inguinal hernioplasty under general anesthesia. Anaphylaxis was diagnosed based on the clinical symptoms and high serum tryptase and histamine levels. Skin tests and BATs with wortmannin were performed, showing similar results to case 1.

Conclusions

BATs suggested an IgE-dependent mechanism for chlorhexidine-induced anaphylaxis and might be useful for investigating the mechanisms underlying drug-induced anaphylaxis.
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Metadata
Title
Intraoperative chlorhexidine-induced anaphylaxis suggesting an immunoglobulin-E-dependent mechanism indicated by basophil activation tests: two case reports
Authors
Masaki Orihara
Tomonori Takazawa
Tatsuo Horiuchi
Kazuhiro Nagumo
Noboru Maruyama
Akihiro Tomioka
Shigeru Saito
Publication date
01-12-2022
Publisher
Springer Berlin Heidelberg
Published in
JA Clinical Reports / Issue 1/2022
Electronic ISSN: 2363-9024
DOI
https://doi.org/10.1186/s40981-022-00581-w

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