Main Article Content
local anesthetics; hypersensitivity; children; immediate reaction; skin test; subcutaneous challenge
Background/objectives: Adverse reactions to local anesthetics are relatively common, but proven IgE-mediated allergy is extremely rare. We aimed to determine the frequency of local anesthetic allergy in pediatric patients.
Patients and methods: The medical records of 73 patients who presented to our clinic with a history of suspected allergic reaction to local anesthetics and underwent diagnostic testing between 2012 and 2020 were retrospectively analyzed. Diagnoses were based on case histories, skin tests, and subcutaneous challenge tests.
Results: A total of 75 test series were carried out on the 73 patients (43 boys; median [IQR] age 9.25 [7.26–14.25] years, range 3–17.8 years). The most commonly tested drugs were lido-caine (n = 38; 50.6%) and prilocaine (n = 15; 20%). Local anesthetic allergy was confirmed in one (1.3%) of the 73 patients by positive subcutaneous challenge test with mepivacaine.
Conclusion: There are limited data in the current literature regarding local anesthetic allergies and diagnosis test results in pediatric patients. Proven local anesthetic allergy is less common than expected by society and physicians, and therefore diagnostic tests are needed for patients with no contra-indications such as severe or life-threatening reactions.
2. Eggleston ST, Lush LW. Understanding allergic reactions to local anesthetics. Ann Pharmacother. 1996;30:851–7. https://doi.org/10.1177/106002809603000724
3. Canfield DW, Gage TW. A guideline to local anesthetic allergy testing. Anesthes Prog. 1987;34:157.
4. Kvisselgaard AD, Mosbech HF, Fransson S, Garvey LH. Risk of immediate-type allergy to local anesthetics is overestimated— results from 5 years of provocation testing in a Danish allergy clinic. J Allergy Clin Immunol Pract. 2018;6:1217–23. https://doi.org/10.1016/j.jaip.2017.08.010
5. Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002;57:45–51. https:// doi.org/10.1046/j.0105-4538.2001.00001.x-i8
6. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100:S1–S148. https://doi.org/10.1016/S1081-1206(10)60305-5
7. Brockow K, Garvey L, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo M, et al. Skin test concentrations for systemi-cally administered drugs–an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68:702–12. https://doi. org/10.1111/all.12142
8. Bhole M, Manson A, Seneviratne S, Misbah S. IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective. Br J Anaesthes. 2012;108:903–11. https:// doi.org/10.1093/bja/aes162
9. Chandler MJ, Grammer LC, Patterson R. Provocative chal-lenge with local anesthetics in patients with a prior history of reaction. J Allergy Clin Immunol. 1987;79:883–6. https://doi.org/10.1016/0091-6749(87)90236-3
10. Berkun Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience with 236 patients. Ann Allergy Asthma Immunol. 2003;91:342–5. https://doi.org/10.1016/S1081-1206(10)61680-8
11. Harboe T, Guttormsen A, Aarebrot S, Dybendal T, Irgens Å, Florvaag E. Suspected allergy to local anaesthetics: fol-low-up in 135 cases. Acta Anaesthesiol Scand. 2010;54:536–42. https://doi.org/10.1111/j.1399-6576.2009.02193.x
12. Batinac T, Sotosek Tokmadzic V, Peharda V, Brajac I. Adverse reactions and alleged allergy to local anesthetics: analy-sis of 331 patients. J Dermatol. 2013;40:522–7. https://doi. org/10.1111/1346-8138.12168
13. Kvisselgaard A, Krøigaard M, Mosbech H, Garvey L. No cases of perioperative allergy to local anaesthetics in the Danish Anaesthesia Allergy Centre. Acta Anaesthesiol Scand. 2017;61:149–55. https://doi.org/10.1111/aas.12833
14. McClimon B, Rank M, Li J. The predictive value of skin test-ing in the diagnosis of local anesthetic allergy. Allergy Asthma Proceed. 2011;32:95-98. https://doi.org/10.2500/ aap.2011.32.3417
15. Yilmaz I, Özdemir S, Aydin Ö, Çelik G. Local anesthet-ics allergy: who should be tested? Eur Ann Allergy Clin Immunol. 2018;50:66–71. https://doi.org/10.23822/EurAnnACI. 1764-1489.38
16. Cetinkaya F. Sensitivity to local anaesthetics among asthmatic children. Int J Paediatr Dentistry. 2001;11:405–8. https://doi. org/10.1046/j.0960-7439.2001.00306.x
17. Kowalski M, Makowska J, Blanca M, Bavbek S, Bochenek G, Bousquet J, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs)–classification, diagnosis and management: review of the EAACI/ENDA# and GA2LEN/HANNA. Allergy. 2011;66:818–29. https://doi.org/10.1111/j.1398-9995. 2011.02557.x