Immunoglobulin-E Mediated Chlorhexidine Hypersensitivity among Healthcare Workers

Objective: With a wide spectrum antimicrobial activity that is not affected by body fluids and blood, chlorhexidine is a particularly useful disinfectant widely used in healthcare settings. Given the importance of disinfectant usage by healthcare workers to prevent nosocomial infections, particularly during the COVID-19 pandemic, this study aims to evaluate the prevalence of immunoglobulin E (IgE)-mediated sensitivity in healthcare workers. Methodology: A cross-sectional study was conducted through a questionnaire and immunoassay for chlorhexidine- specific IgE in healthcare workers in a large teaching hospital in London, UK. The prevalence of IgE-mediated chlorhexidine hypersensitivity was determined along with potential determinants. Results: With a 77.7% response rate, the study showed that 4 out of 233 participants were positive for chlorhexidine-specific IgE, with an overall prevalence of 1.72% (95% Confidence Interval: 0.05% to 3.39%). All the positive cases belonged to occupationally exposed healthcare workers. In this group, the prevalence rate was 2.82% (95% Confidence Interval: 0.1% to 5.54%). Conclusion: Chlorhexidine is a potential allergen and an under-reported cause of anaphylaxis in patient-care and occupational settings. The results suggest that chlorhexidine has a relatively safe profile for healthcare workers in occupational settings, but a higher prevalence of chlorhexidine hypersensitivity cannot be ruled out. Sensitized healthcare workers must be advised to avoid further exposure to prevent potentially serious IgE-mediated allergic symptoms. Further studies are recommended to determine if any change in disinfection guidelines and protocols is warranted.