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I thank you for pointing out the error1Sokol WN. Reply to Post cystoscopy anaphylaxis. J Allergy Clin Immunol Pract 2016;4:189.Google Scholar related to the Ask the Expert Question in the Journal of Allergy and Clinical Immunology: In Practice.2Lieberman P. Anaphylaxis after cystoscopy.J Allergy Clin Immunol Pract. 2014; 3: 469-470Abstract Full Text Full Text PDF Scopus (4) Google Scholar I have reviewed your letter and have discussed with Dr. Lieberman. Unexpected causes of operative anaphylaxis include both ortho-phthalaldehyde and chlorhexidine.3Sokol W.N. Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy.J Allergy Clin Immunol. 2004; 114: 392-397Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar, 4Suzukawa M. Komiya A. Koketsu R. Kawakami A. Kimura M. Nito T. et al.Three cases of ortho-phthalaldehyde-induced anaphylaxis after laryngoscopy: detection of specific IgE in serum.Allergol Int. 2007; 56: 313-316Abstract Full Text PDF PubMed Scopus (29) Google Scholar, 5Krautheim A.B. Jermann T.H.M. Bircher A.J. Chlorhexidine anaphylaxis: case report and review of the literature.Contact Dermatitis. 2004; 50: 113-116Crossref PubMed Scopus (149) Google Scholar, 6Dyer J.E. Nafie S. Mellon J.K. Khan M.A. Anaphylactic reaction to intraurethral chlorhexidine: sensitisation following previous repeated uneventful administration.Ann R Coll Surg Engl. 2013; 95: e105Crossref PubMed Scopus (17) Google Scholar, 7Abdallah C. Perioperative chlorhexidine allergy: Is it serious?.J Anaesth Clin Pharmacol. 2015; 31: 152-154Crossref Scopus (31) Google Scholar You are correct; one of the references cited in the original article as a source for chlorhexidine is your report describing ortho-phthalaldehyde anaphylaxis.3Sokol W.N. Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy.J Allergy Clin Immunol. 2004; 114: 392-397Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar Both ortho-phthalaldehyde and chlorhexidine should be considered as causes of surgical, and particularly urologic surgery, anaphylaxis. Chlorhexidine sensitization may occur through the use of mouthwash, toothpaste, and skin disinfectants, and chlorhexidine may be used for almost any surgical procedure, whereas ortho-phthalaldehyde reactions are more likely with multiple endoscopies. Chlorhexidine is a more common cause of allergic contact dermatitis and eczema rather than acute hypersensitivity reactions and anaphylaxis. Recognition of these compounds as potential causes of anaphylaxis and avoidance of subsequent use with a history of operative anaphylaxis and sensitization are important considerations, as you clearly state. Dr. Lieberman and I thank you for bringing this to our attention. Post Cystoscopy AnaphylaxisThe Journal of Allergy and Clinical Immunology: In PracticeVol. 4Issue 1PreviewI am writing this letter in response to a previously published article,1 in which Dr. Phillip Lieberman responded to a question from an allergist about a patient who developed anaphylaxis after cystoscopy. Dr. Lieberman wrote that the disinfectant “chlorhexidine should be considered as a possible causative agent.” He then cited an article I published in the Journal of Allergy and Clinical Immunology2 and an article by Dyer et al,3 as references for chlorhexidine-induced anaphylaxis. However, the agent in our article was not chlorhexidine, but rather ortho-phthalaldehyde (product name CIDEX-OPA). Full-Text PDF