Nasal IL‐15 levels are similar between asthmatics and controls during asthma exacerbations and viral upper respiratory infections: 361

Abstract

Felix L. Chan, HBSc., Asad A. Merchant, MD FRCP(C), Nikki Breede, BSc, RRT, and Susan M. Tarlo, MBBS FAAAAI; University of Toronto Faculty of Medicine, Toronto, ON, Canada, Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, ON, Canada, Division of Respirology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada. RATIONALE: Chlorhexidine is an antimicrobial agent used in the dialysis setting for disinfection of skin and fistula/catheter exit sites. Allergic reactions to chlorhexidine have been reported; recently, there have been several case reports of anaphylaxis from chlorhexidine-impregnated central lines in dialysis patients undergoing renal transplantation. Dialysis patients and healthcare workers may be at risk for chlorhexidine sensitization. METHODS: Nurses and patients were recruited from hemodialysis units at the Toronto General Hospital and administered a questionnaire regarding allergic symptoms to chlorhexidine and/or a chlorhexidine skin prick test (SPT). Specific IgE (sIgE) to chlorhexidine was measured from plasma samples of participants with allergy-suggestive symptoms or SPTs. Independent samples t-test and Fisher’s exact test were used for analyses. RESULTS: We recruited 63 participants (29 nurses and 34 patients). Compared to patients, nurses had longer (146 vs 84 months, p<0.05) and more frequent chlorhexidine exposures (62% vs 12% reporting >_4 exposures/week, p<0.001). Most nurses (76%) reported regular direct skin exposure to chlorhexidine. Pruritus associated with chlorhexidine and absent with other cleaning agents was reported by 41%of patients and 14% of nurses (p<0.05). Positive SPT responses were observed in 10% of patients and 9% of nurses. One nurse and 2 patients had both chlorhexidine-associated pruritus and a positive SPT. Users of chlorhexidine foam (n52) and wipes (n51) recalled associated severe pruritus and/or a rash. CONCLUSIONS: We found a 6% generalized prevalence (3% of nurses and 9% of patients) of chlorhexidine allergy in a hemodialysis setting. Our study will continue by assessing associations of findings with sIgE measurements.