Immediate- and delayed-type allergic reactions to amide local anesthetics: clinical features and skin testing

2009 ◽  
Vol 18 (7) ◽  
pp. 595-601 ◽  
Author(s):  
Régis Fuzier ◽  
Maryse Lapeyre-Mestre ◽  
Paul-Michel Mertes ◽  
Jean-François Nicolas ◽  
Yves Benoit ◽  
...  
Keyword(s):  
Clinical Features ◽  
Local Anesthetics ◽  
Skin Testing ◽  
Allergic Reactions

Understanding Allergic Reactions to Local Anesthetics

1996 ◽  
Vol 30 (7-8) ◽  
pp. 851-857 ◽  
Author(s):  
Steven T Eggleston ◽  
Lori W Lush
Keyword(s):  
Local Anesthetic ◽  
Local Anesthetics ◽  
English Language ◽  
Case Reports ◽  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Alternative Therapies ◽  
Allergic Reactions ◽  
Medline Search ◽  
Mesh Terms

OBJECTIVE: To review the pharmacology and mechanisms by which local anesthetics cause allergic reactions. Recommendations concerning appropriate use of local anesthetics and alternative therapies in patients with documented local anesthetic allergies are given. DATA SOURCE: A MEDLINE search of the English-language literature identified pertinent clinical studies, case reports, and reviews. The periods of review were Med1, 1990-present; and Med2, 1985-1989, using the MeSH terms drug hypersensitivity and anesthetics. References from the selected studies, case reports, and reviews were reviewed. STUDY SELECTION: Controlled and uncontrolled prospective studies and case reports pertaining to local anesthetic allergies were reviewed. The selection focused on information pertaining to the etiology and diagnosis of allergic reactions to local anesthetics and alternative therapies for patients with local anesthetic allergies. DATA SYNTHESIS: Local anesthetics are classified as either ester or amide compounds. Esters are associated with a higher incidence of allergic reactions, due to a p-aminobenzoic acid (PABA) metabolite. Amide agents do not undergo such metabolism. However, preservative compounds (methylparaben) used in the preparation of amide-type agents are metabolized to PABA. Patients who are allergic to ester local anesthetics should be treated with a preservative-free amide local anesthetic. If the patient is not allergic to ester local anesthetics, these agents may be used in amide-sensitive patients. In the rare instance that hypersensitivity to both ester and amide local anesthetics occurs, or if skin testing cannot be performed, then alternative therapies including diphenhydramine, opioids, general analgesia, or hypnosis can be used. CONCLUSIONS: A true immunologic reaction to a local anesthetic is rare. Intradermal skin testing of local anesthetic compounds, methylparaben, and metabisulfite should be performed in patients when a thorough history does not rule out a possible allergic reaction to local anesthetics and future local anesthesia is necessary. Skin testing enables the clinician to identify autonomic responses to minor surgical procedures and toxic reactions to anesthetics so that patients are not incorrectly labeled as “caine” allergic. Diphenhydramine can be used as an alternative to ester and amide local anesthetics in minor procedures of short duration.

scholarly journals Lidocaine: A Local Anesthetic, Its Adverse Effects and Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 782
Author(s):  
Entaz Bahar ◽  
Hyonok Yoon
Keyword(s):  
Adverse Effects ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Adverse Reactions ◽  
Rapid Diagnosis ◽  
Diagnosis And Treatment ◽  
Allergic Reactions ◽  
Life Threatening

The most widely used medications in dentistry are local anesthetics (LA), especially lidocaine, and the number of recorded adverse allergic responses, particularly of hazardous responses, is quite low. However, allergic reactions can range from moderate to life-threatening, requiring rapid diagnosis and treatment. This article serves as a review to provide information on LA, their adverse reactions, causes, and management.

Risk groups of patients at the dentist with a burdensome allergy history

2021 ◽  
Vol 41 (1) ◽  
pp. 59-62
Author(s):  
O. M. Boychenko ◽  
◽  
T. M. Moshel ◽  
I. Yu. Popovich ◽  
◽  
...  
Keyword(s):  
Local Anesthetics ◽  
Oral Fluid ◽  
Allergic Diseases ◽  
Risk Groups ◽  
Local Injection ◽  
Allergic Reactions ◽  
Outpatient Basis ◽  
Laboratory Methods ◽  
Adaptive Capabilities ◽  
Toxic Reactions

Local injectable anesthesia is widely used in modern dentistry. First of all, the purpose of anesthesia in the practice of the doctor is to relieve the patient’s emotional stress and eliminate pain during the procedure. According to the classical position of N. E. Vvedensky, local anesthetics affect the functional state of the nerve, changing its conductivity and excitability. With the help of questionnaires we conducted a survey of 65 patients aged 18 to 75 years who sought medical help at the regional dental center in Poltava. The results of a questionnaire of doctors on the use of local anesthetics in dental practice were also analyzed. With the help of laboratory methods of examination of oral fluid, a decrease in the rate of salivation, saliva pH, leukocyte migration rate was determined. The purpose of the survey was to identify the frequency of manifestations of various allergic reactions to drugs in patients. All patients were systematized by age and comorbidities, which further affected their distribution. The distribution of patients by risk groups (allergy history) allowed to assess the prevalence of allergic diseases depending on age and sex. Particular attention was paid to elderly and senile patients, as their condition is characterized by a decrease in compensatory and adaptive capabilities. Patients with somatic pathology and persons with multiple foci of chronic odontogenic infection should be classified as at risk for the development of allergic reactions to local anesthetics, which should be taken into account when performing local injection anesthesia on an outpatient basis. It should be remembered that concomitant pathology affects the choice of anesthetic and can determine the development of toxic reactions during local injection anesthesia in the head and neck. This category of patients requires dentists to take a more responsible approach to collecting medical history and taking preventive measures to prevent the development of allergic and toxic reactions to local anesthetics.

Skin testing after anaphylactoid reactions to dental local anesthetics

1993 ◽  
Vol 75 (6) ◽  
pp. 706-711 ◽  
Author(s):  
Timothy A. Hodgson ◽  
Penelope J. Shirlaw ◽  
Stephen J. Challacombe
Keyword(s):  
Local Anesthetics ◽  
Skin Testing ◽  
Anaphylactoid Reactions

Oral Induction of Immunological Tolerance to Chromium in the Guinea Pig

1990 ◽  
Vol 69 (10) ◽  
pp. 1634-1639 ◽  
Author(s):  
K.J.J. Vreeburg ◽  
I.M.W. Van Hoogstraten ◽  
B.M.E. Von Blomberg ◽  
K. De Groot ◽  
R.J. Scheper
Keyword(s):  
Skin Testing ◽  
Tolerance Induction ◽  
Immunological Tolerance ◽  
Metal Alloys ◽  
High Dose ◽  
Allergic Reactions ◽  
Dose Frequency ◽  
Chromium Powder ◽  
Adverse Side Effects ◽  
Skin Contact

Metal alloys used in dentistry may elicit adverse side-effects. Contact allergic reactions to metals released from such alloys are among the most frequently encountered problems. In an earlier study, we observed that oral contacts with nickel or chromium salts did not sensitize, but rather decreased the risk of subsequent sensitization to these metals. In the present study, we focused on chromium allergy and extended our earlier observations by further dose-response studies. In addition, we compared different chromium valencies as to their potential oral tolerogenic effects. Development of immunological tolerance in chromium-fed guinea pigs was demonstrated by their inability to develop chromium hypersensitivity after a subsequent immunization attempt. For these studies, the techniques of immunization and skin testing were first improved. One feeding with a high dose of K2Cr2O7, (containing hexavalent chromium) was effective in full tolerance induction. In contrast, trivalent chromium (CrCl3) induced a distinctly lower degree of tolerance, whereas metallic chromium powder was not detectably tolerogenic after a limited number of feedings. Dose-frequency-response studies with K2Cr2O 7, showed that full tolerance could also be induced by an increase in the number of feedings with sub-optimal tolerogenic doses. The present results therefore support our hypothesis that long-lasting oral contact with chromium-releasing metal alloys may ultimately result in strong immune tolerance to this metal in subjects without previous skin contact with it. This view is further supported by recent insights into the unique tolerogenicity of oral, as compared with gastro-intestinal, allergenic contacts.

Ranitidine-induced anaphylaxis: clinical features, cross-reactivity, and skin testing

2016 ◽  
Vol 46 (4) ◽  
pp. 631-639 ◽  
Author(s):  
K. H. Park ◽  
J. Pai ◽  
D.-G. Song ◽  
D. W. Sim ◽  
H. J. Park ◽  
...  
Keyword(s):  
Clinical Features ◽  
Skin Testing ◽  
Cross Reactivity

scholarly journals Problems of diagnostic evaluation and prophylaxis of drug allergy to local anesthetics

2009 ◽  
Vol 6 (2) ◽  
pp. 18-23
Author(s):  
L V Luss ◽  
N V Shartanova ◽  
I V Luss ◽  
N V Shartanova
Keyword(s):  
Clinical Features ◽  
Local Anesthetics ◽  
Drug Allergy ◽  
Diagnostic Evaluation

This review represents modern data about the mechanisms, clinical features, diagnostics problems and prophylaxis of drug allergy to local anesthetics.

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