Anaesthetic Allergy Research Articles

Administration of local anesthetics to patients with a history of prior adverse reaction

The clinical histories of 71 patients evaluated for suspected local anesthetic (LA) allergy were reviewed retrospectively. The clinical histories were classified into (1) immediate generalized reactions (15%), (2) localized swelling at the injection site (25%), (3) nonspecific systemic symptoms (42%), and (4) other histories (17%). Serial dilutional intradermal skin tests were performed with mepivacaine, lidocaine, and procaine in 59 patients. There were 5 skin test-positive patients found, and each had a positive reaction to an LA to which, by history, they had not reacted. In 50 patients, when an LA was subsequently required, a subcutaneous challenge was performed with an LA chosen for chemical nonsimilarity. No significant reactions were observed in this group. Three patients tolerated a challenge with an LA to which they were skin test-positive. These data indicate (1) the low incidence of reactions compatible with a systemic IgE-mediated mechanism by history in patients referred for evaluation of LA allergy, (2) the lack of specific and clinically relevant information provided by dilutional skin tests, and (3) the apparent safety and usefulness of careful challenge with an alternative LA.

Anguish Over Contradictory Articles

As a sufferer from fairly severe hay fever, I read with great interest the article by Johnstone et al.,1 hypothesizing a connection between general anesthesia and respiratory allergy. My interest was heightened because I underwent a hernia repair at Strong Memorial Hospital at age 16 months. The article by Ballantine et al.2 in the same issue leads me to believe that I should have had my operation in Boston. The two articles are absolutely contradictory.