RESUMEN
BACKGROUND: Chlorhexidine generally has a good safety profile. However, allergic reactions are reported with increasing frequency. In China, it is rarely reported, and its characteristics are unknown. The purpose of this study was to summarize the experience of a Chinese allergy center with chlorhexidine allergy. METHODS: The authors retrospectively reviewed all patients who underwent chlorhexidine allergy testing in the Allergy Center of West China Hospital, Sichuan University (Chengdu, China), in the period February 2018 to May 2022 (n = 43 patients) and included the patients diagnosed with chlorhexidine allergy for analysis. RESULTS: Ten patients who were diagnosed by skin prick and serum-specific immunoglobulin E tests were included. They experienced a total of 30 allergic reactions to chlorhexidine (mean ± SD, 3.0 ± 1.3). Five patients experienced six allergic reactions (6 of 30, 20%) during general or local anesthesia, and they may have been exposed to chlorhexidine via different routes. Only one allergic reaction (1 of 30, 3%) was recorded with exposure via a mouthwash. The other 23 allergic reactions (23 of 30, 77%) were caused via a skin disinfectant; the route of exposure was IV cannulation in 22 allergic reactions (22 of 23, 96%) and broken skin in one allergic reaction (1 of 23, 4%). The symptoms included a quick onset and great severity. Two patients (2 of 10, 20%) had been accidentally re-exposed to chlorhexidine after diagnosis. CONCLUSIONS: This study conducted in China showed that the majority of reactions to chlorhexidine were attributed to skin disinfectants, and IV cannulation was the most common exposure route; in general, however, chlorhexidine allergy was easily overlooked. The potential allergenicity of chlorhexidine used for skin preparation before IV cannulation or should be considered in patients who develop allergic reactions perioperatively.
Asunto(s)
Hipersensibilidad a las Drogas , Hipersensibilidad Inmediata , Hipersensibilidad , Humanos , Clorhexidina/efectos adversos , Estudios Retrospectivos , Hipersensibilidad Inmediata/inducido químicamente , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/epidemiología , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/epidemiología , Hipersensibilidad a las Drogas/etiologíaRESUMEN
Objective:To investigate the value of nasal provocation testï¼NPTï¼ in evaluating the efficacy of allergen immunotherapyï¼AITï¼ in patients with dust mite induced allergic rhinitisï¼ARï¼. Methods:A total of 83 patients with dust mite induced AR with/without asthma were included. Symptom scoreï¼SSï¼, daily medication scoreï¼DMSï¼, combined symptom and medication scoreï¼CSMSï¼, rhinoconjunctivitis quality of life questionnaireï¼RQLQï¼, NPT and skin prick testï¼SPTï¼ were assessed before and after 1 year AIT. Results:There were statistical differences in SSï¼P<0.000 1ï¼, DMSï¼P<0.000 1ï¼, CSMSï¼P<0.000 1ï¼, and RQLQï¼P<0.000 1ï¼ after 1 year of AIT compared with pre-treatment. The effective rate of CSMS was 73.49%, and the effective rate of NPT was 42.17%. CSMS was consistent with NPT in efficacy assessmentï¼Kappa=0.437, P<0.001ï¼; while in 54 patients with pre-treatment NPT concentrations other than the original concentration, CMSM and NPT showed better consistenceï¼Kappa=0.895, P<0.001ï¼. Among the 48 patients with ineffective NPT assessment in the first year, 25 patients completed the second-year follow-up, and 12 patientsï¼48.00%ï¼ showed effective in NPT. However, 10 out of 12 patientsï¼83.33%ï¼ with NPT concentration other than original solution pre-treatment showed effective NPT at the second year. Conclusion:NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients, especially for patients with positive NPT induced at lower concentrations before treatment.
Asunto(s)
Pyroglyphidae , Rinitis Alérgica , Animales , Humanos , Alérgenos , Pruebas de Provocación Nasal , Calidad de Vida , Rinitis Alérgica/diagnóstico , Rinitis Alérgica/terapia , Desensibilización Inmunológica , Pruebas Cutáneas , PolvoRESUMEN
BACKGROUND: Allergen identification is the first step for allergen-specific immunotherapy (AIT) of allergic rhinitis (AR). Currently, the diagnosis of AR is based mainly on the positive results of the skin prick test (SPT) and/or serum specific immunoglobulin E (sIgE) measurement. However, the results of these two tests may not always directly correlate with AR. OBJECTIVE: To investigate the importance of nasal provocation testing (NPT) in the diagnosis of Dermatophagoides pteronyssinus (Der p)-induced AR. METHODS: Rhinitis patients willing to undergo AIT (n = 171) were enrolled. The correlations of Der p SPT, sIgE, NPT, and clinical symptom severity were assessed. RESULTS: NPT-positive responses were more common in patients with higher SPT and sIgE levels. The optimal cut-off value for a NPT-positive response for SPT was 5.5â mm and for sIgE was 2.77â kUA/L, based on the respective receiver operating characteristic (ROC) curves. The area under the curve (AUC) of the ROCs was 0.814 (SPT only) and 0.794 (sIgE only) and increased to 0.828 with the combination of SPT and sIgE. The Der p-NPT concentration was inversely correlated with SPT and sIgE levels (r = -0.477, P < .001, and r = -0.461, P < .001, respectively), but none was correlated with the total nasal symptom score. CONCLUSION: For patients who are willing to receive Der p AIT, NPT is a useful and safe test to confirm diagnosis prior to treatment initiation, especially in patients with lower levels of Der p SPT (< 5.5â mm) or sIgE (< 2.77â kUA/L).