Use of Povidone Iodine for Endophthalmitis Prophylaxis linked to Iodine Allergy
Iodine is a necessary element for life, thus an allergy to elemental iodine is not possible. Nevertheless, iodine containing chemicals can provoke 3 types of reactions on human contact: an irritant contact dermatitis, an allergic contact dermatitis, and a generalized anaphylaxis.
First, an irritant reaction to iodine is an effect of the body's innate immune system and, as such, a skin response can be provoked immediately without prior exposure. Compared with tinctures of pure iodine, these types of reactions are less frequent with the lower levels of free iodine encountered with iodophores, but they are still common and depend on the exposure time and concentration. As opposed to an irritant reaction, an allergic reaction to the iodophore is mediated by T lymphocytes.
In a review published in The Journal of Vitreoretinal Diseases ,authors have discussed the role of povidone-iodine (PI) for endophthalmitis prophylaxis in ophthalmic procedures, stating that it is an essential component, that true PI allergy is rare, and that reported allergy to iodine, shellfish, or contrast media is not a contraindication.
It is now well documented that the antiseptic povidone iodine (PI) is a key component of endophthalmitis prophylaxis. Due to wide evidence of data showing that PI effectively reduces bacterial counts in 30 seconds and that the fastest in vitro killing time is achieved with 0.1% PI rather than more-concentrated formulations, The American Academy of Ophthalmology recommends using 5% PI,25 and recent in vivo studies have shown that 5% PI is as effective as 10% in the setting of IVIs.
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