Local Anesthetic Allergy Research Articles

795. Local Anaesthetic Allergy Testing in Pregnancy

795. Local Anaesthetic Allergy Testing in Pregnancy

Local Anaesthetic Allergy Testing in Pregnancy

Local Anaesthetic Allergy Testing in Pregnancy

795: Local Anaesthetic Allergy Testing in Pregnancy

795: Local Anaesthetic Allergy Testing in Pregnancy

A critical review of local anesthetic sensitivity

With their ability to block pain signals to the brain, local anesthetics (LAs) have made possible many surgical procedures and interventions once thought impossible. LAs are generally safe and well tolerated when used correctly by trained professionals. However, adverse reactions do occur, and may generate a referral to an Allergist for evaluation of LA allergy. LA structure, classification, and metabolism will be briefly reviewed. A critical analysis of the studies and case reports involving LA allergy found via PubMed search for "local anesthetic allergy" and "local anesthetic hypersensitivity" will be discussed. In addition, the clinical evaluation of a patient with concern for a LA allergy will be examined.

Local Anesthetic Allergy Characterized by Type IV Reactions in Patients Who Received Dental Anesthesia

Local Anesthetic Allergy Characterized by Type IV Reactions in Patients Who Received Dental Anesthesia

Thoracotomy in a Patient with a History of Local Anesthetic Allergy

Thoracotomy in a Patient with a History of Local Anesthetic Allergy

Benzyl Alcohol with Epinephrine: An Alternative Anesthetic for Laceration Repair

Although the incidence of true local-anesthetic allergy is low, alternative agents must be used for patients who report such allergy. Ester anesthetics can be substituted if the patient has a documented amide allergy, but it is often unclear whether the allergy is to the anesthetic itself or to the methylparaben …

Alleged allergy to local anaesthetics.

The aim of this study was to determine the incidence of true local anaesthetic allergy in patients with an alleged history of local anaesthetic allergy and whether subsequent exposure to local anaesthetics is safe. Two hundred and eight patients with a history of allergy to local anaesthesia were referred over a twenty-year period to our Anaesthetic Allergy Clinic. In this open study, intradermal testing was performed in three patients and progressive challenge in 202 patients. Four patients had immediate allergy and four patients delayed allergic reactions. One hundred and ninety-seven patients were not allergic to local anaesthetics. In 39 patients an adverse response to additives in local anaesthetic solutions could not be excluded. In all but one patient local anaesthesia has been given uneventfully subsequently. A history of allergy to local anaesthesia is unlikely to be genuine and local anaesthetic allergy is rare. In most instances LA allergy can be excluded from the history and the safety of LA verified by progressive challenge.

When pharmacologic anesthesia is precluded: the value of hypnosis as a sole anesthetic agent in dentistry.

Occasionally, a dental patient presents his/her dentist with a history of hypersensitivity to local anesthetic agents. The symptoms may include immediate reactions to the injection procedure (dizziness, shortness of breath, tachycardia, etc), or delayed reactions to the anesthetic (swelling, urticaria, etc). Although the true incidence of local anesthetic allergy is low, such a history often involves the patient's anxiety regarding the use of the drug in question, and the dentist's apprehension to treat the "problematic" patient. In such cases, hypnosis can play a major role in controlling pain and the associated distress. In the present article, the method concerning the implementation of hypnosis to induce local anesthesia is described and illustrated through case demonstrations.

Provocative challenge with local anesthetics in patients with a prior history of reaction

Possible allergic sensitivity to local anesthetic agents remains problematic for some patients who could benefit from their use. We retrospectively reviewed all our consultations for evaluation of local anesthetic allergy from 1965 to 1985 to assess the safety and efficacy of skin testing and provocative test dosing with a variety of local anesthetic agents. Fifty-nine patients reported 70 reactions from the administration of six different local anesthetics. Fifty-four patients could name one or more local anesthetic agents they believed were responsible, and five patients named only “caine” drugs. Multiple reactions of the same type to the same agent were considered as one reaction. On the basis of their history of reaction, the patients were categorized as follows: anaphylactoid reactions (urticaria, angioedema, wheezing, or hypotension within 1 to 2 hours of exposure), possible anaphylactoid reactions (tachycardia, dizziness, syncope, breathlessness, or pruritus occurring within 1 to 2 hours of exposure), contact dermatitis (a typical eczematous skin eruption after appropriate cutaneous sensitization), and other reactions (nonanaphylactoid reactions other than those already described or those occurring more than 2 hours after exposure). Fifty-nine patients were administered local anesthetics after skin testing and provocative test dosing, including two patients who required intravenous lidocaine (Xylocaine; Astra Pharmaceutical Products, Inc., Westboro, Mass.) acutely to control cardiac arrhythmias. These two patients had reported anaphylactoid reactions to oral antiarrhythmic drugs of the local anesthetic class. Despite the history of previous reactions, there were no positive skin tests or positive provocative drug challenges in any patients. We conclude that local anesthetics can be safely and effectively used despite the history of previous reactions if skin tests are negative and if incremental challenge is used. Patients reporting immediate reactions to oral and parenteral antiarrhythmic local anesthetics may be skin tested and cautiously challenged with these drugs. A protocol for performing these tests is suggested.

Administration of Local Anesthetics to Patients with a History of Prior Adverse Reaction

INCAUDO, G.; SCHATZ, M.; PATTERSON, R.; ROSENBERG, M.; YAMAMOTO, F.; HAMBURGER, R. N. Author Information

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.