Delayed‐type hypersensitivity to bupivacaine

Nettis, Eustachio; Colanardi, Maria Cristina; Calogiuri, Gianfranco; Foti, Caterina; Priore, M. G.; Ferrannini, A.; Vacca, Aldo

doi:10.1111/j.1398-9995.2007.01468.x

Cited by 15 publications

(8 citation statements)

References 4 publications

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“…The other contributory factor in the death of the present case may be explained as a hypersensitivity reaction to bupivacaine. A case report detailing a delayed hypersensitivity reaction to bupivacaine can be found in the medical literature (27). Tryptase, a component of mast cell secretory granules, is elevated when mast cell activation occurs and serves as a marker of anaphylaxis.…”

Section: Resultsmentioning

confidence: 99%

Fatality Involving Complications of Bupivacaine Toxicity and Hypersensitivity Reaction*

Dudley

Fleming

Garg

et al. 2011

Journal of Forensic Sciences

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This case represents unusual findings of elevated bupivacaine and tryptase concentrations following local anesthetic, bupivacaine, administered as a scalene nerve block for elective rotator cuff repair surgery. Following bupivacaine injection, the patient exhibited almost immediate seizure activity, bradycardia, and cardiac arrest. Resuscitative efforts including cardiopulmonary bypass restored a cardiac rhythm. However, the clinical medical status of the patient progressively declined and he died 7 h following administration of the local anesthetic. Autopsy revealed several abnormalities of the heart including cardiomegaly, myocardial bridging, and lipomatous hypertrophy of the intraatrial septum, which may have contributed to bradycardia and arrhythmia. Postmortem toxicology results revealed elevated bupivacaine and tryptase concentrations. Elevated postmortem bupivacaine concentrations 7 h following administration and abrupt onset of seizures indicate unintentional intravascular injection instead of nerve and tissue infiltration. An elevated postmortem tryptase concentration points to the possibility of a hypersensitivity reaction to bupivacaine.

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Section: Resultsmentioning

confidence: 99%

Fatality Involving Complications of Bupivacaine Toxicity and Hypersensitivity Reaction*

Dudley

Fleming

Garg

et al. 2011

Journal of Forensic Sciences

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“…These observations are in accordance with case reports covering the same range from superficial eczematous to deep cellulitis-like reactions. 7,8,[30][31][32][33][34][35] The term "deep impact contact allergy" has been proposed to refer to the latter. 8 In a previous case report, we reported that LAs may be clinically tolerated despite sensitization if they are deliberately injected into the deep subcutaneous tissue.…”

Section: Localized Allergy Casesmentioning

confidence: 99%

Differential diagnosis of late‐type reactions to injected local anaesthetics: Inflammation at the injection site is the only indicator of allergic hypersensitivity

Trautmann

Stoevesandt

2018

Contact Dermatitis

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Background: Anaphylaxis-like reactions developing within a few minutes are the most frequent complications of subcutaneous or submucosal injections of local anaesthetics (LAs), and topically applied LAs are potential contact allergens. In addition, injected LAs have been reported to induce delayed reactions, including local inflammation at the injection site, and various general symptoms.Objectives: To assess the frequency and symptoms of late-type hypersensitivity occurring several hours after LA injections.Methods: We retrospectively evaluated clinical data and test results from all patients referred to our allergy clinic in a period of 20 years for diagnostic work-up of LA-associated late-type reactions.Results: Of 202 patients reporting symptoms with onset at least 1 hour after LA injection, 40 had cutaneous inflammation confined to the injection site, and 162 reported various systemic symptoms. LA hypersensitivity could be excluded in all patients with systemic complaints by means of skin testing and subsequent subcutaneous provocation. In 8 of the 40 patients (20%) with local inflammatory reactions, late-type allergic LA hypersensitivity was confirmed.Conclusions: Late-type LA allergy commonly causes inflammatory skin reactions confined to the injection site. Conversely, LAs are highly unlikely to trigger delayed systemic symptoms such as urticarial or exanthematous skin eruptions.

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“…It is known that anaphylaxis occurs when 2000 nearby antibodies attached to mast cell surface are bridged by corresponding antigens and make the critical number of 1000 bridges. [5] In another patient with an initial negative skin prick test with undiluted 0.75% bupivacaine a second subcutaneous challenge test (simple blind) with 0.1 ml dose (1:100 diluted) rendered mild symptoms such as heavy feeling in her arms and itching in the eyes. [1] In the very interesting paper published in this Journal, [2] a 59-year-old healthy male developed rashes in his upper limb, chest, and abdomen followed by breathlessness, tachycardia, severe hypotension, and cardiovascular collapse 2 min after intravenous injection of 1 g amikacin.…”

Section: Amikacin Bupivacaine Fentanyl and Kounis Syndromementioning

confidence: 99%

“…[3] Hence, all patients who suffer peri-operative anaphylaxis required a detailed history and examination for drug allergy. [5] There is no cross-reactivity between amide and ester LA, except in preservative related allergy. Anaphylaxis has rarely been reported as delayed presentation especially after IV exposure and generally occurs within few minutes of IV injection unless otherwise in compromised circulation like cardiac arrest.…”

Section: Sirmentioning

confidence: 99%