Eray YILDIZ, Fatih ÇÖLKESEN, Filiz Sadi AYKAN, Recep EVCEN, Mehmet KILINÇ, Gökhan AYTEKİN, Şevket ARSLAN

Allergic reactions to local anesthetics: should we test those with drug allergies and atopy history?

Aim: Many patients are referred to allergy clinics for allergy tests to local anesthetics. The aim of this study was to evaluate the effect of a history of atopy and drug hypersensitivity on allergy tests made with local anesthetics. Materials and Methods: A retrospective review was made of the records of patients referred to our clinic within a 5-year period because of a suspicion of allergy to local anesthetics, and who were applied with skin tests and subcutaneous challenge tests. Results: Evaluation was made of a total of 138 patients, comprising 114 (82.6%) females and 24 (17.4%) males with a mean age of 45.35 ± 14.13 years. A reaction during a dental procedure was reported in 99 (71.7%) patients. Mepivacaine was the most tested local anesthetic (n = 66, 40.2%). A positive reaction was determined in the skin tests made with local anesthetics in 6 (4.3%) patients. Lidocaine was the local anesthetic most often showing a positive reaction (n = 3, 50%). A history of atopy was present in 30 (21.7%) patients. No correlation was determined between atopy history and the development of a positive reaction to local anesthetics (p = 0.086). In the cases determined with a positive reaction to local anesthetics, there was a greater rate of history of hypersensitivity to drugs other than local anesthetics (p = 0.012). Conclusion: Patients with a history of drug hypersensitivity reaction should be tested in respect of local anesthetic allergy prior to a procedure to be made with local anesthetics.

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1. Kvisselgaard AD, Mosbech HF, Fransson S, et al. Risk of Immediate-Type Allergy to Local Anesthetics Is Overestimated Results from 5 Years of Provocation Testing in a Danish Al lergy Clinic. J Allergy Clin Immunol Pract. 2018;6(4):1217-23.
2. Bhole MV, Manson AL, Seneviratne SL, et al. IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective. Br J Anaesth. 2012;108(6):903-11.
3. Kvisselgaard AD, Kroigaard M, Mosbech HF, et al. No cases of perioperative allergy to local anaesthetics in the Danish Anaes thesia Allergy Centre. Acta Anaesthesiol Scand. 2017;61(2):149- 55.
4. Ring J, Franz R, Brockow K. Anaphylactic reactions to local anesthetics. Chem Immunol Allergy. 2010;95:190-200.
5. Becker DE, Reed KL. Local anesthetics: review of pharmacolog ical considerations. Anesth Prog. 2012;59(2):90-101; quiz 2-3.
6. Malinovsky JM, Chiriac AM, Tacquard C, et al. Allergy to local anesthetics: Reality or myth? Presse Med. 2016;45(9):753-7.
7. Erdeljic V, Francetic I, Likic R, et al. Is referring patients with a positive history of allergic drug reactions or atopy for allergy testing to local anesthetics justified? Methods Find Exp Clin Pharmacol. 2009;31(3):177-82.
8. Bina B, Hersh EV, Hilario M, et al. True Allergy to Amide Local Anesthetics: A Review and Case Presentation. Anesth Prog. 2018;65(2):119-23.
9. I YI, Özdemir SK, Aydin Ö, et al. Local anesthetics allergy: who should be tested? Eur Ann Allergy Clin Immunol. 2018;50(2):66- 71.
10. Petersen TH, Bohlke A. [Allergic reactions to local anaesthetics]. Ugeskr Laeger. 2018;180(39).
11. Eggleston ST, Lush LW. Understanding allergic reactions to lo cal anesthetics. Ann Pharmacother. 1996;30(7-8):851-7.
12. Morais-Almeida M, Gaspar A, Marinho S, et al. Allergy to lo cal anesthetics of the amide group with tolerance to procaine. Allergy. 2003;58(8):827-8.
13. Cuesta-Herranz J, de las Heras M, Fernandez M, et al. Allergic reaction caused by local anesthetic agents belonging to the amide group. J Allergy Clin Immunol. 1997;99(3):427-8.
14. Nakamura N, Tamagawa-Mineoka R, Masuda K, et al. Immediate-type allergic reactions to local anesthetics. Allergol Int. 2018;67(1):160-1.
15. Gülbahar O, Mete N. Allergic Reactions Due to Local Anes thetics: Are They As Frequent as Expected? T Clin J Allergy Asthma. 2002;4(3):109-14.