Chlorobutanol


Preservative with hypnotic, sedative, antiseptic and anesthetic properties used in many externally applied products as well as in drugs (vasopressin, heparin, oxytocin).
 
Incidence
Uncommon. One death reported.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: pruritus, maculopapular eruption.
 
Diagnostic methods
Cutaneous testing.
  • Intradermal skin-tests using chlorobutanol at 0.5%. One positive result was reported in a patient with a maculopapular eruption.
     
  • One positive scratch test in a patient with anaphylactic shock.
Intravenous challenge with chlorobutanol was positive in a patient 5 minutes after 1 ml of 1/1000 chlorobutanol solution.
 
Mechanisms
Undetermined.
 
Management
Avoid use of drugs containing this preservative.

References

  1. Maycock E.J, Russell W.C, "Anaphylactoid reaction to Syntocinon*", Anaesth. Intensive. Care., 1993; 21 (2): 211-2
  2. Hofman H, Goerz G, Plewig G, "Anaphylactic shock from chlorobutanol-preserved oxytocin", Contact Dermatitis, 1986; 15 (4): 241-2
  3. Slater R.M, Bowles B.J.M, R, Pumphrey R.S.H, "Anaphylactoid reaction to oxytocin in pregnancy", Anaesthesia, 1985; 40: 655-6
  4. Itabashi A, Katayama S, Yamaji T, "Hypersensitivity to chlorobutanol in DDAVP solution", Lancet, 1982; 1 (8263): 108
  5. Dux S, Pitlik S,Perry G, Rosenfeld J.B, "Hypersensitivity reaction to chlorbutol-preserved heparin", Lancet, 1981 1 (8212):149.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.