povidone-iodine and Drug-Hypersensitivity

"Iodine allergy" does not exist. The concept of "iodine allergy" should be abandoned since it may result in inappropriate measures such as drug, food or environmental eviction. Immediate or non-immediate allergic hypersensitivity to iodinated contrast media is not infrequent. The corresponding allergens have not been identified. Iodine is not involved. Immediate or non-immediate allergic hypersensitivity to povidone iodine is rare. The corresponding allergen is povidone in case of immediate hypersensitivity while nonoxynol might be involved during non-immediate hypersensitivity. Seafood allergens belong to a group of muscle proteins. Immediate drug hypersensitivity or food hypersensitivity is assessed by immediate-reading skin tests while non-immediate drug hypersensitivity is investigated by delayed-reading skin testing. Combined histamine and tryptase measurement is invaluable during the diagnostic approach of immediate hypersensitivity. Other biological tests are being evaluated. Allergic hypersensitivity to iodinated contrast agents does not contraindicate the use of other iodinated drugs.

Topics: Allergens; Amiodarone; Anaphylaxis; Animals; Anti-Infective Agents, Local; Biomarkers; Contrast Media; Dermatitis, Contact; Dietary Proteins; Drug Hypersensitivity; Food Hypersensitivity; Histamine Release; Humans; Hypersensitivity, Immediate; Iodine; Iodine Compounds; Muscle Proteins; Potassium Iodide; Povidone-Iodine; Seafood; Skin Tests; Thyroxine; Tryptases

Topics: Anti-Infective Agents, Local; Antifungal Agents; Calcium Hydroxide; Drug Combinations; Drug Hypersensitivity; Fibroblasts; Gingiva; Humans; Iodine Compounds; Povidone-Iodine; Root Canal Irrigants

Povidone-iodine is an antiseptic widely used in dermatology. In vitro experiments showed a certain cytotoxicity, yet it is not easy to transfer these toxicological data to in vivo circumstances. In vivo investigations in animals and in humans could exclude cytotoxic effects of povidone-iodine, measured by the wound healing process. Only when administered in combination with detergents was an obvious cytotoxicity seen in wounds but not on the intact skin. In comparison to the frequently used antibiotic neomycin, the sensitization rate of povidone-iodine is very low.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Detergents; Drug Hypersensitivity; Humans; Iodophors; Neomycin; Povidone-Iodine; Skin; Wound Healing

Topics: Anesthesia, Conduction; Anti-Infective Agents, Local; Drug Hypersensitivity; Humans; Iodine; Ophthalmologic Surgical Procedures; Povidone-Iodine

To present cases of endophthalmitis following intravitreal injections where povidone-iodine (PI) was not used as part of the surgical preparation.. Retrospective case series.. All cases of presumed injection-related endophthalmitis presenting to the Massachusetts Eye and Ear Infirmary between June 2008 and November 2014 and Dean McGee Eye Institute between January 2010 and January 2015 were identified. Patients who did not receive PI preparation owing to documented self-reported allergy to iodine, iodine-containing contrast material, or shellfish were identified and their injection histories and clinical courses reviewed.. The combined rate of postinjection endophthalmitis at these 2 centers was 0.019%. Among 42 patients with postinjection endophthalmitis, 5 (11.9%) did not receive PI prophylaxis. The mean number of intravitreal injections without PI before the development of endophthalmitis was 10.6 with a 9.4% rate of endophthalmitis (5 cases per 53 injections). All patients underwent tap-and-inject procedures with vancomycin 1 mg and ceftazidime 2 mg. Two patients did not receive PI at the time of tap and inject; 1 of these patients required subsequent pars plana vitrectomy for worsening clinical course. Cultures were positive in 4 of 5 cases; all positive cultures grew coagulase-negative Staphylococcus. All patients who received subsequent intravitreal injections received PI prophylaxis without allergic reactions, thus demonstrating a lack of true PI allergy.. Avoiding PI owing to self-reported iodine "allergy" risks substantial ocular morbidity. Allergy testing can be pursued per patient request or in rare cases of suspected true PI allergy; however, in cases where delayed treatment would adversely affect visual outcome, the clinician should feel confident that minimal allergic risk exists.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Bacterial Agents; Drug Hypersensitivity; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Middle Aged; Povidone-Iodine; Retrospective Studies; Self Report; Staphylococcal Infections; Staphylococcus; Vascular Endothelial Growth Factor A

Concise guidelines are presented that recommend the method of choice for skin antisepsis before central neuraxial blockade. The Working Party specifically considered the concentration of antiseptic agent to use and its method of application. The advice presented is based on previously published guidelines, laboratory and clinical studies, case reports, and on the known properties of antiseptic agents.

Topics: Antisepsis; Chlorhexidine; Drug Hypersensitivity; Ethanol; Humans; Nerve Block; Neurotoxicity Syndromes; Povidone-Iodine; Skin

Topics: Cephalosporins; Drug Hypersensitivity; Eye Diseases; Humans; Ophthalmic Solutions; Penicillins; Povidone-Iodine

Povidone-iodine, a surgical antiseptic, is associated with adverse side effects ranging from minor skin irritation to anaphylaxis, with symptoms occurring within minutes and up to 8 hours after contact.. We report a case of a patient, with no history of allergy to povidone-iodine, who developed an allergic reaction 24 hours after intraoperative exposure to povidone-iodine, presenting with acute urinary retention secondary to extensive vulvar edema, which resolved after administration of antihistamines.. Allergic reactions to povidone-iodine can be late in onset and, in vaginal surgeries, may present with atypical symptoms such as acute urinary retention secondary to vulvar edema. Prompt diagnosis and effective treatment requires strong clinical suspicion in patients presenting postoperatively with a known history of exposure.

Topics: Anti-Infective Agents, Local; Drug Hypersensitivity; Edema; Female; Histamine Antagonists; Humans; Middle Aged; Povidone-Iodine; Time Factors; Urinary Retention; Vulvar Diseases

Topics: Adult; Anaphylaxis; Anesthesia, General; Anti-Infective Agents, Local; Contraindications; Drug Hypersensitivity; Dyspnea; Humans; Hydrocortisone; Intraoperative Care; Intraoperative Complications; Male; Orthopedic Procedures; Povidone-Iodine; Urticaria

Anaphylaxis during anaesthesia is a rare event which is mainly related to neuromuscular blocking agents. Latex and antibiotics are less frequently incriminated. However, allergy may be triggered by other less frequent and hidden allergen. Among these, povidone is largely used in numerous therapeutics and cosmetics. We report here an exceptional case of grade 3 anaphylactic shock with iodinated povidone administered via a rectal route.

Topics: Administration, Rectal; Anaphylaxis; Anti-Infective Agents, Local; Colectomy; Colonic Diseases; Combined Modality Therapy; Crystalloid Solutions; Diagnostic Errors; Drug Hypersensitivity; Epinephrine; Food Hypersensitivity; Humans; Intestinal Perforation; Isotonic Solutions; Male; Methylprednisolone; Middle Aged; Povidone-Iodine; Preanesthetic Medication; Shock, Septic; Wernicke Encephalopathy

Topics: Anaphylaxis; Anesthesia; Contrast Media; Drug Hypersensitivity; Humans; Iodine; Iohexol; Povidone-Iodine

Allergic dermatitis around the catheter exit site, caused by topical antiseptics such as povidone iodine and chlorhexidine gluconate, is an uncommon complication in patients on chronic peritoneal dialysis (CPD). As yet, published reports concerning this rare non catheter-related complication are few. The frequency of this type of dermatitis is not known, because reports of isolated cases constitute the only source of information. Here, we report our clinical experience with 2 patients (2.3%) among the 86 children with end-stage renal disease who underwent CPD treatment at our center during the period between November 1995 and December 2004. These 2 pediatric patients developed allergic contact dermatitis, with extensive patchy and linear erythema around the exit-site area because of administration of povidone iodine solution. The symptoms subsided within a week in both patients after daily topical application of normal saline solution was started. Allergic dermatitis caused by povidone iodine at the site of the catheter exit should be kept in mind as a complication in patients on CPD. Antiseptic solutions should be used cautiously in these patients.

Topics: Adolescent; Anti-Infective Agents, Local; Catheters, Indwelling; Child, Preschool; Dermatitis, Allergic Contact; Drug Hypersensitivity; Humans; Male; Peritoneal Dialysis; Povidone-Iodine

Topics: Anaphylaxis; Anti-Infective Agents, Local; Drug Hypersensitivity; Humans; Povidone-Iodine

Topics: Adult; Anaphylaxis; Anti-Infective Agents; Drug Hypersensitivity; Humans; Immunoglobulin E; Male; Povidone; Povidone-Iodine; Radioimmunoassay; Skin Tests

Silver sulfadiazine cream is a topical antibacterial agent that combines the antibacterial effects of both silver and sulfadiazine. Its reported cutaneous side effects include hypersensitivity reactions, allergic contact dermatitis, erythema multiforme, and systemic argyria. We report the case of a patient who had localized argyria develop in a scar after the use of silver sulfadiazine cream. In this case, the silver sulfadiazine cream was applied to and argyria developed within a postsurgical wound and area of severe contact dermatitis.

Topics: Administration, Cutaneous; Aged; Anti-Infective Agents; Anti-Infective Agents, Local; Argyria; Coronary Artery Bypass; Dermatitis, Contact; Drug Hypersensitivity; Humans; Postoperative Complications; Povidone-Iodine; Silver Sulfadiazine

In dermatological surgery where the lesions to be removed are very often contaminated with bacteria, local use of antiseptics that are effective against a wide range of germs is often indicated. Polyvinylpyrrolidone (povidone = PVP)-bound iodine (in Hungary marketed as Betadine is used successfully in our department. After excision and suture in per primam healing wounds as well as after tissue destruction in per secundam healing wounds, a thin layer of Betadine ointment on the dressing right after surgery and at dressing changes may reduce the risk of wound infection. When the defect requires split-thickness skin grafting, a combination of tulle gras and a layer of gauze soaked with 1:10 dilution of Betadine solution is suggested. In the treatment of leg ulcers, Betadine is used for cleansing and for impregnating the gauze on top of the tulle gras layer both in the debridement and in the epithelization phases. PVP-I is beneficial on burn wounds due to its effect reducing bacterial colony counts. Its use is advised for superficial (grades 1 and 2a) burns as well as surgical debridement of deep burns or temporary xenograft or definitive autograft coverage of these wounds. After treating a large number of patients with Betadine, a statement can be made: despite its theoretical risk, no cytostatic effect is seen in the clinical setting. No allergy towards Betadine was observed among the author's patients over several years of its use. Fifty patients previously treated with PVP-I were challenged with epicutaneous patch testing, and no sensitization was found. An account is made on the adverse effects attributed to Betadine found in the scientific literature, and its use with regard to the proper indications is suggested.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Burns; Child; Child, Preschool; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Povidone-Iodine; Skin Tests; Surgical Wound Infection

Topics: Anaphylaxis; Drug Hypersensitivity; Female; Hernia, Hiatal; Humans; Middle Aged; Postoperative Complications; Povidone-Iodine

Patch testing with Iodine/potassium-iodide (3%) and commercialized povidone (PVP)-iodine preparations (Betaisodona-ointment and solution, Polyvidon-Jod-ointment "Braun", Braunol-solution "Braun", Traumasept-ointment, and Traumasept solution--not marketed--, were carried out in 104 patients of the Department of Dermatology of the Municipal Hospital Kassel. In addition, the according ointment and solution-bases were tested. 22 tests were patients with ulcera crurum, 82 patients with infectious skin diseases or skin tumors. 35 out of the 104 patients showed positive reactions to iodine/potassium-iodide. Hyperreactivity to one or more PVP-iodine-ointments was found in 12 patients, to one or more PVP-iodine solutions in 29 patients. If there was no positive reaction to iodine/potassium-iodide, PVP-iodine ointments were always tolerated, while PVP-iodine-solutions produced positive reactions in 9 cases even then. Our results show that allergic skin reactions must be expected in 2-9% of all patients using PVP-iodine ointments, and in 12-20% of all patients using PVP-iodine-solutions. If iodine-allergy is known the rate of positive reactions to PVP-iodine ointments is 6-25% to the solutions 34-60%.

Topics: Drug Hypersensitivity; Humans; Iodine; Patch Tests; Pharmaceutical Vehicles; Potassium Iodide; Povidone; Povidone-Iodine; Skin