Adverse reaction to dental local anaesthetic injection – 'allergy' is not the cause

Rood, J.

doi:10.1038/sj.bdj.4800776a

Cited by 22 publications

(30 citation statements)

References 9 publications

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“…Częściej spotykane są reakcje alergiczne typu komórkowego, a najczęściej objawy nadwrażliwości niealergicznej [11]. Większość objawów niepożądanych, z których część może naśladować reakcje nadwrażliwości, wiąże się jednak z innymi przyczynami, takimi jak: działania toksyczne, wpływ jednoczesnego podania adrenaliny, omdlenia wazowagalne, reakcje lękowe lub zespół hiperwentylacji [10,12].…”

Section: Definicjeunclassified

Nadwrażliwość na leki znieczulenia miejscowego

Grzanka¹,

Wasilewska²,

Śliwczyńska³

et al. 2016

Anaesthesiol Intensive Ther

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Using local anaesthetics in daily practice, particularly by anaesthesiologists and dentists, is related to the risk of adverse reactions. Therefore, monitoring of such reactions, carrying out detailed documentation (according to the chart proposed in this study) and conducting specialist examinations is of the greatest importance. There is a variety of adverse reactions that may occur during local anaesthesia procedures, with the intensity ranging from clinically insignificant to life-threatening reactions. The majority of concerns reported by clinicians are linked to the appearance of various hypersensitivity reactions, including anaphylaxis. Healthcare providers responsible for the administration of local aneasthetics should be able to detect hypersensitivity reactions in order to implement appropriate treatment and then choose diagnostic procedure. The final diagnosis should be based on detailed history, medical record, including a case description and measurements of tryptase activity, skin tests and provocation trials. Screening tests are not currently recommended in individuals without hypersensitivity to local anaesthestics in history.Key words: hypersensitivity; local anestehtics; local Słowa kluczowe: znieczulenie miejscowe, środki znieczulające, nadwrażliwość; znieczulenie miejscowe, środki znieczulające, testy skórne Anestezjologia Intensywna Terapia 2016, tom 48, nr 2, 135-141Wprowadzenie do praktyki klinicznej leków znieczu--lających miejscowo zrewolucjonizowało procedury zabiegowe. W 1884 roku austriacki lekarz Carl Koller skutecznie znieczulił powierzchniowo kokainą rogówkę oka do zabiegu okulistycznego. Obecnie leki znieczulenia miejscowego (LZM) są szeroko stosowane w wielu dziedzinach medycyny z różnymi możliwościami ich aplikacji. Częste stosowanie znieczuleń miejscowych nie może pozostać bez wpływu na zwiększenie prawdopodobieństwa wystąpienia działań niepożądanych środków tej grupy, w tym także reakcji nadwraż-liwości [1]. Efekty niepożądane leków, które wynikają z ich farmakologicznego mechanizmu działania lub z nasilenia objawów zależnych od dawki są zazwyczaj dobrze poznane i stąd możliwe do przewidzenia. W odróżnieniu do nich, reakcje nadwrażliwości na leki ciągle wywołują dyskusje, a ich diagnostyka stanowi ogromne wyzwanie dla klinicystów. W ostatnich dwóch latach poczyniono jednak pewne postępy. Opublikowano międzynarodowe wytyczne ekspertów [2−5], które próbują uporządkować zagadnienie nadwrażliwości na leki, problem będący jednym z najbardziej enigmatycznych tematów alergologii [6]. Zawarte w nich zalecenia odnoszą się również do nadwrażliwości na LZM.

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Section: Definicjeunclassified

Nadwrażliwość na leki znieczulenia miejscowego

Grzanka¹,

Wasilewska²,

Śliwczyńska³

et al. 2016

Anaesthesiol Intensive Ther

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“…Only case reports of confirmed local anaesthetic allergies exist in the literature, making it difficult to accurately report on the prevalence. Rood completed skin and intraoral challenges of 44 adult patients suspected of having a local anaesthetic allergy to conclude that a confirmed allergy was not present in any of the cases but rather most reactions were of a psychogenic origin …”

Section: Introductionmentioning

confidence: 99%

Investigation and diagnosis of an immediate allergy to amide local anaesthetic in a paediatric dental patient

Allen

Chan

Gue

2017

Australian Dental Journal

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Local anaesthetics remain the most common prescription medication utilized in dental practise. Adverse reactions following administration of local anaesthetic are somewhat common and are frequently reported as 'allergies'. However, of these events, it is estimated that only 1% are confirmed allergies to the local anaesthetic. This case report presents the process of referral for investigation and testing to confirm an amide local anaesthetic allergy in a paediatric patient. Testing for a safe alternative was also completed to identify local anaesthetic agents also of the amide variety that could be utilized safely on this individual. Following skin testing of alternative agents, intraoral challenges were completed. Finally, restorative dental treatment was provided safely for the patient with the use of an alternative amide local anaesthetic on a number of occasions with no further adverse outcomes.

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“…[9][10][11][12][13] It has been estimated that true immunologic adverse reactions occur in approximately 1% of all adverse systemic reactions. 6 This paper reviews serious adverse reactions to dental local anaesthetics which have been reported to the Office of Product Review of the Therapeutics Goods Administration (TGA). Recent case histories managed by the South Australian Oral and Maxillofacial Surgery Unit are also presented.…”

Section: Introductionmentioning

confidence: 99%

“…However, when severe adverse systemic reactions to dental local anaesthesia are investigated, true allergy is rare. 6,7 Toxic drug overdose, rapid absorption, intravascular injection, cardiovascular, central nervous system, psychogenic or idiosyncratic reactions are much more likely to occur. Indeed, it has been suggested that true allergic reactions to local anaesthetics do not occur or are a myth.…”

Section: Introductionmentioning

confidence: 99%

Severe adverse reactions to dental local anaesthetics: systemic reactions

Sambrook

Smith

Elijah³

et al. 2011

Australian Dental Journal

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Background: Occasionally, patients suffer systemic adverse effects from injections of local anaesthetic solutions. This may range from minor transient vasovagal attacks to life-threatening collapse. Methods: The suspected adverse reactions reported to the Office of Product Review of the Therapeutic Goods Administration (TGA) were analysed in detail.Results: There was a high incidence (70%) of adverse reactions associated with prilocaine, which is much greater than its market share (less than 20%). There is a tendency to consider all systemic adverse reactions as being 'allergic' reactions although this is rarely the case. Syncope, cardiovascular and central nervous system reactions are much more common. There is also a risk of methaemoglobinaemia to prilocaine and articaine. A small series of cases referred to one of the authors were also reported. Conclusions: Recommendations are made as to the prevention, acute care and subsequent investigation of adverse reactions. The most important conclusion is not to just label the response as allergic and to use an alternative agent. Detailed investigation and reporting should be made for all cases of suspected severe adverse reaction to local anaesthetic agents.

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Adverse reaction to dental local anaesthetic injection – 'allergy' is not the cause

Cited by 22 publications

References 9 publications

Nadwrażliwość na leki znieczulenia miejscowego

Nadwrażliwość na leki znieczulenia miejscowego

Investigation and diagnosis of an immediate allergy to amide local anaesthetic in a paediatric dental patient

Severe adverse reactions to dental local anaesthetics: systemic reactions

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