The passively sensitized mast cell activation test is a reliable diagnostic for chlorhexidine allergy

Abstract

Chlorhexidine (CHX) is a synthetic cationic biguanide that harbors 2 biguanide groups both linked to a terminal 4-chlorophenyl group with the resultant chlorguanide structures connected by a hexamethylene bridge. Chlorhexidine can cause life-threatening anaphylaxis due to specific immunoglobulin E (sIgE) antibody–mediated activation of basophils and mast cells (MCs) and is generally associated with mucosal or parenteral exposure. Although it was originally thought to be very rare, in some countries, CHX has now become an important—often hidden and overlooked—cause of perioperative hypersensitivity (POH).