Lidocaine Allergy Research Articles

A case report: Anaphylactic reaction to chloroprocaine in a patient with mastocytosis and lidocaine allergy

This case report presents a 53-year-old woman with a history of mastocytosis and reported lidocaine allergy who experienced an anaphylactic reaction following administration of chloroprocaine during a breast biopsy procedure. The patient was promptly treated with epinephrine, methylprednisolone, famotidine, and diphenhydramine, leading to stabilization. She was subsequently transferred to the intensive care unit (ICU) for observation and discharged after 24 hours. This case highlights the importance of vigilance and preparedness for managing anaphylactic reactions in patients with mastocytosis and known allergies to local anesthetics.

Correlation between skin test results and historical manifestations in patients with suspected lidocaine hypersensitivity.

Background: Adverse reactions to local anesthetics (LA) are relatively common; however, true IgE-mediated allergy is extremely rare, estimated to occur in less than 1%. Investigating patients with suspected allergy to LA should begin with a detailed history to exclude other more common operation theater related culprit medications, followed by skin testing. The subcutaneous challenge is considered the gold standard for confirming true IgE-mediated allergy to LA. In this study, we have described the skin prick test results of patients with suspected lidocaine allergy who had historical reaction symptoms typical to IgE-mediated allergic reactions.Methods: The data were retrieved from the allergy procedure log registry for patients who were referred to the allergy clinic with a suspected allergic reaction to lidocaine at the Hamad Medical Corporation between 2016 and 2020. These patients’ symptoms of historical reactions to lidocaine were compared to their skin test results.Result: A total of 7 patients were identified. The skin test result for lidocaine was positive in only 1 patient; his historical reaction was anaphylaxis (urticaria/angioedema and shortness of breath). The remaining 6 patients had a negative result for skin and challenge tests. Of these 6 patients with negative results, 4 had only urticaria/angioedema as historical reactions; 1 had systematic manifestation (tachycardia) along with urticaria/angioedema, and 1 experienced systemic symptoms (shortness of breath, chest pain, and palpitation) with no skin or mucous membrane involvement (Table 1).Conclusion: Negative skin test and subcutaneous challenge with a history of generalized cutaneous symptoms and/or systemic symptoms during the reaction to LA can be attributed to many causes, such as an IgE-mediated reaction against a component other than lidocaine (e.g., latex), medication side effects (adrenaline in combined preparations), and/or symptoms of primary disease (chronic spontaneous urticaria/angioedema).

Extraction of a wisdom tooth in patient with possible true lidocaine allergy: a case report

Extraction of a wisdom tooth in patient with possible true lidocaine allergy: a case report

M400 MANAGING A CASE OF REPORTED LOCAL LIDOCAINE ALLERGY IN A PREGNANT WOMAN DURING COVID-19 PANDEMIC

We report how we diagnosed and managed a case of reported local anesthetic allergy in a high-risk pregnant woman during the COVID-19 pandemic via telemedicine. We were consulted by the obstetrician for lidocaine allergy in advance of a spinal block for an elective cesarean section in a 23-year-old woman at 34 weeks of gestation. The patient had a past medical history of ulcerative colitis and a surgical history of having a colectomy and ostomy. The patient reported a previous episode of localized hives and swelling shortly after undergoing a dental procedure that was thought to be secondary to her receiving a lidocaine injection. She denied cardiopulmonary and gastrointestinal symptoms, anxiety or delayed reactions. Therefore IgE-mediated hypersensitivity was possible. Due to the COVID-19 pandemic, we conducted the initial assessment and the subsequent planning with multiple providers involved in the case through a Telehealth route. At 38 weeks of gestation, in a pre-delivery room with fetal monitoring, the patient passed both skin prick and intradermal testing for lidocaine (10mg/ml), preservative free lidocaine (10 mg/ml) and preservative free bupivacaine (2.5 mg/ml). Subsequently, she passed a subcutaneous skin challenge with 1 ml of preservative free lidocaine (10 mg/ml). A few hours later, she delivered a baby uneventfully by cesarean section under spinal block using local preservative free lidocaine. We report the management of reported lidocaine allergy on a pregnant patient during COVID-19 pandemic via both telemedine and pre-delivery on-site skin testing. We successfully removed the label of lidocaine allergy immediately before her delivery.

The incidence of lidocaine allergy in dentists: an evaluation of 100 general dental practitioners.

Local anesthetics are some of the most common drugs used in dentistry and about 6 million people daily around the world are subjected to their effect in procedures performed by a similar number of dentists who, in turn, are usually not aware of the fact of being allergic to this group of medications. Assuming that dentists are also patients, and that in their daily practice the contact with the allergen is very frequent, it is essential to assess the incidence of allergy to lidocaine in general dental practitioners. The authors evaluated a group of 100 general dental practitioners in whom adverse reactions similar to anaphylaxis occurred after local anesthesia. The study included individuals who, in their thorough medical history, had experienced episodes of such reactions regarding the skin, airways, gastrointestinal tract and other areas. The relations between type I hypersensitivity and certain symptoms, time from exposure to their appearance, as well as time from the last episode were investigated. Allergy to lidocaine was detected in 17 subjects - type I hypersensitivity was diagnosed in 13 cases (skin prick test - 7; intradermic test - 6) and 4 subjects had IgE-independent allergy (patch test). In the group where type I hypersensitivity was detected, urticaria, angioedema and rhinitis were indicated as inclusion criteria more often than among other subjects. According to the results, the occurrence of angioedema increased the risk of detection of type I hypersensitivity 68.8 times, and 1 year longer period from the last episode decreased this risk by circa 55%. The most important, from the clinical practice point of view, was to show the relation between the medical history indicating the anaphylactic nature of the lidocaine intolerance, and an allergy confirmed by skin tests. Int J Occup Med Environ Health. 2019;32(3):333-9.

Lidocaine Allergy: Do Positive Patch Results Restrict Future Use?

Adverse reactions from lidocaine are commonly reported. When allergy is suspected, patients may be referred for specific skin testing to confirm the association of their clinical findings. We aimed to investigate 13 cases of suspected lidocaine allergy to analyze if positive patch results restricted future use as an injectable local anesthetic. A prospective study was conducted from March 2013 to September 2014 at 2 academic hospital-based patch test clinics in Toronto. Patients were tested to the North American Contact Dermatitis Group standard series (Smart Practice, Phoenix, AZ) and, if suspicion for lidocaine allergy was high, a local anesthetic series (Chemotechnique Diagnostics, Malmö, Sweden) was added. Intradermal skin testing to local anesthetics below irritant concentrations was subsequently conducted in lidocaine-positive patients. If negative, a subcutaneous challenge with 1% lidocaine was done. Thirteen of 756 patients patch tested were positive to lidocaine. Seven patients had relevant reactions to over-the-counter products containing lidocaine, 2 reacted to subcutaneous lidocaine, and 4 had incidental findings. There were no patients with positive results to intradermal testing. Three patients had delayed reactions to the subcutaneous challenge. Patients with positive patch tests to lidocaine and negative results to intradermal testing and subcutaneous challenge may be safe to use lidocaine as an injectable local anesthetic in the future.

Electrophysiologic Monitoring for Placement of Laminectomy Leads for Spinal Cord Stimulation Under General Anesthesia

Spinal cord stimulation (SCS) is a valid option for intractable neuropathic pain syndromes, yet some patients cannot undergo the standard awake procedure. Our retrospective study chronicles laminectomy-electrode placement for SCS under general anesthesia and use of compound muscle action potentials (CMAPs) to guide placement in the absence of patient verbal feedback. After nonsurgical measures proved ineffective for relief of neuropathic pain, 8 men and 11 women underwent SCS lead placement under general rather than local anesthesia because of deafness, language barriers, lidocaine allergy, or extensive scar tissue. A midline thoracic laminectomy was performed, and paddle SCS leads were placed. CMAPs of the rectus abdominis, quadriceps, gastrocnemius, anterior tibialis, abductor hallicus, and intercostal muscles were analyzed. Final lead placement was determined by the right-to-left symmetry of the CMAPs in conjunction with fluoroscopic imaging. Stimulation coverage was evaluated postoperatively. Inconsistencies were found in lower-extremity CMAPs in the first two procedures. Thereafter, intercostal and rectus abdominis muscle CMAPs obtained in the remaining 17 procedures were consistent, more predictive of final results. Immediately postoperatively, 16 (84.2%) of 19 patients had adequate stimulation coverage and good pain relief with appropriate programming. Of three (15.8%) patients with minimal or no short-term pain relief, lack of response was not attributable to inadequate distribution of stimulation. With electrophysiologic monitoring and fluoroscopy guidance, placement of SCS laminectomy leads in select patients under general anesthesia may result in appropriate stimulation coverage and pain relief in most.

Prevalence of benzocaine and lidocaine patch test sensitivity in Denmark: temporal trends and relevance

BACKGROUND. Allergens included in the European baseline series should result in positive patch test reactions in at least 1% of a patch test population. Inclusion of local anaesthetics other than benzocaine in the baseline series has previously been debated. To investigate temporal trends of benzocaine and lidocaine allergy in dermatitis patients who underwent routine patch testing in a tertiary referral patch test centre, and to clarify and discuss whether lidocaine and benzocaine should be included in routine series. Dermatitis patients who underwent routine patch testing with benzocaine as a part of the European baseline series between 1985 and 2010 (n = 19 347) and dermatitis patients who underwent routine patch testing with lidocaine between 1994 and 2001 (n = 6265) and between 2007 and 2009 (n = 1360) were included. The overall prevalences of contact allergy were 0.5% (benzocaine), 0.3% (lidocaine for the period 1994-2001), and 0.14% (lidocaine for the period 2007-2009). Current relevance was observed in 10% of those with benzocaine allergy and in 5% of those with lidocaine allergy. Benzocaine and lidocaine allergy is infrequent in Danish dermatitis patients. Lidocaine should only be used for aimed testing, and benzocaine should be removed from the baseline series used in Denmark.

Acupuncture Anesthesia for Complicated Dental Extractions in Patients with Lidocaine Allergy

Clinical presentation of the soft tissue abscess and periodontitis of the buccal gingiva of the upper right first molar after the metal crown was removed.

Lidocaine in Bronchoscopy

Topical lidocaine is commonly used to obtain airway mucosal anesthesia during flexible bronchoscopy. Although its safety profile is excellent and there are few reports of adverse effects and allergies, precautions are necessary to avoid using lidocaine inappropriately and to avoid excess administration in patients at risk for lidocaine-related adverse events. The purpose of this article is to identify indication and profiles of various forms of lidocaine preparations, describe the properties of lidocaine and other topical and local anesthetics of the amide and ester groups used for bronchoscopy, to briefly identify adverse events related to toxicity and review existing literature pertaining to allergic reactions, and to discuss a practical decision-making approach to assure patient safety in case of documented or suspected lidocaine allergy.

Bicarbonate-treated gastroendoscopy

14138 Background: Endoscopy is the most powerful examination to detect cancer. We showed efficacy and feasibility of the bicarbonate(bC)-treated gastroendoscopy (bCGE) to the patients (Y. Kim, et al. ICACT2004, Paris, France, and Y. Kim. 2006 GI Cancers Symposium, San Francisco, CA, USA). We tried an alternative preparation, divided alkalization, to modify the bCGE to less threaten patients in the examination. Methods: Enrollment-criteria was described; age 20 to 85, Performance Status 0 to 2, and no history of lidocaine (L) allergy, no wound in the oral cavity, and no severe organ dysfunction. The alkalizing-agent was 7-% sodium-bC solution (S-bC). The divided bC-treatment was shown: gurgling and swallowing a half, 10-mL, of 20-mL S-bC divided by L application into two parts, the 1st and the 2nd alkalization. pH Levels in the left pharyngeal-arch were measured. The patients were applied a deffervescent agent orally, L sprays in the pharyngeal-arch and L gel onto the pharyngeal-wall for 5-minute, and gastrointestinal-paralyzing agents intramuscularly. The reflexes (coughing and nausea), and pulse rates (PR) of the patients were monitored in the bCGE. Results: This study analyzed 9-patient in intent-to-treat method. All patients, 100%, accomplished the bCGE with the divided alkalization. Course of pH Levels, incidence of the reflexes and increasing ratio of PR were given in the table below. The divided alkalization enhanced the L effects in the pH Levels after the 2nd alkalization depending manner. Conclusions: We found the bCGE with the divided alkalization might be effective and feasible. The pH Levels after the 2nd alkalization could be the predictive factors for the successful bCGE with the divided alkalization. [Table: see text] No significant financial relationships to disclose.

Evaluation of Re-Challenge in Patients with Suspected Lidocaine Allergy

Background: Lidocaine is an anaesthetic agent used worldwide in various clinical specialties. Although lidocaine hypersensitivity is very rare, clinicians frequently encounter patients with such an alleged diagnosis. Using a questionnaire, we evaluated the results of re-challenge with lidocaine, the gold standard for assessing hypersensitivity reactions in patients who claim to be allergic to this drug. Methods: A detailed questionnaire was sent to members of the French Dermatological Society, targeting the management of patients claiming lidocaine intolerance. After analysis and recall of doubtful episodes, 199 re-challenges were made. True lidocaine hypersensitivity was finally demonstrated in only 1 patient. Conclusions: The results of this study demonstrate that patients claiming to be allergic to lidocaine are usually not, their symptoms corresponding in most cases to a vasovagal episode. Re-challenge is safe and may constitute an easy and cheap alternative to skin testing. This should be performed in specialized centres except in case of a vasovagal episode.

A pregnant woman with previous anaphylactic reaction to local anesthetics: A case report

A 43-year-old woman with a history of lidocaine allergy required dermatologic surgery during pregnancy. To accomplish this without the use of general anesthesia, intradermal allergy testing was performed. This information enabled appropriate anesthetic care for a tissue biopsy at 29 weeks’ gestation and subsequent labor analgesia and obstetric management at term. (Am J Obstet Gynecol 2001;185:1253–4.)

A Case of Suspected True Lidocaine Allergy

A Case of Suspected True Lidocaine Allergy