Abstract

Chlorhexidine is known to sensitise skin' and has been associated with severe allergic reactions.2 We are not aware of any previous report of an association between asthma and the use of chlorhexidine and alcohol aerosols. We describe two cases.
Case reports
Case I-A 54 year old nursing auxiliary presented with a three month history of increasingly frequent attacks of cough and wheezing. These episodes occurred within minutes after she used a chlorhexidine and alcohol aerosol (Dispray 2 Hard Surface Disinfectant, Stuart Pharmaceuticals, Wilmslow, Cheshire) to disinfect incubators. She had been a cigarette smoker previously but did not have a history of asthma and was not receiving treatment for asthma. Spirometric testing gave normal results, with the ratio of forced expiratory volume in one second to forced vital capacity being 3-4:4 2 litres (81%). The concentration of histamine causing a 20% fall in the forced expiratory volume in one second was 9-2 g/l, indicating borderline hyperresponsiveness of the airways.3 A bronchial provocation test that mimicked the woman's normal use of the aerosol was performed, during which she cleaned the work surfaces in a small ventilated laboratory with this agent for 30 minutes. Spirometric values were recorded over the next eight hours and compared with those taken over eight hours on a control day. The forced expiratory volume in one second fell by 13% 10 minutes after the challenge, and this was associated with cough and chest tightness. No late response was observed.
Case 2-A 43 year old midwife presented with a six month history of chest tightness after exposure to a chlorhexidine and alcohol aerosol (Dispray 2). She was a non-smoker and did not have a history of asthma, but she had recently been prescribed a salbutamol inhaler. Spirometric tests gave normal results, with the ratio of forced expiratory volume in one second to forced vital capacity being 3A49:4 05 litres (86%). A histamine
challenge test indicated normal airways responsiveness, the concentration of histamine causing a 20% fall in the forced expiratory volume in one second being >16 g/l.3 The patient recorded peak expiratory flow rates five times daily. At work there was a 43-48% variation between maximum and minimum values compared with less than 10% variation away from work
(figure). A bronchial provocation test with the aerosol showed a maximum fall in forced expiratory volume in one second of 22% two minutes after exposure to the spray. No late response was observed.

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