Delayed-Type Hypersensitivity to Lidocaine

Mackley, Christine L.; Marks, James G.; Anderson, Bryan

doi:10.1001/archderm.139.3.343

Cited by 71 publications

(38 citation statements)

References 23 publications

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“…Mackley et al [24], however, reported that of 183 patients patch tested four had positive reactions to lidocaine, two of whom had histories of sensitivity to local injections of lidocaine manifested by dermatitis. They concluded that contact type IV sensitivity to lidocaine may occur more frequently than was previously thought.…”

Section: Toxicitymentioning

confidence: 99%

Local anesthetics

Heavner

2007

Current Opinion in Anaesthesiology

138

103

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Section: Toxicitymentioning

confidence: 99%

Local anesthetics

Heavner

2007

Current Opinion in Anaesthesiology

138

103

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“…Only a few cases of type I immediate hypersensitivity reaction [4] and type IV delayed hypersensitivity [5,6] …”

Section: Discussionmentioning

confidence: 99%

An Unusual Complication with Use of Lignocaine: A Case Report

Meshram¹,

Meshram²,

Lambade

et al. 2015

JCDR

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A 50-year-old male reported to the Department of Oral & Maxillofacial Surgery of Chhattisgarh dental college & research institute, Rajnadgaon for removal of a carious tooth in lower right region of the jaw. As a part of general protocol a detailed case history was taken prior to the procedure and skin testing for allergy was planned prior to the extraction. The patient's past medical history was unremarkable. The patient was informed of the possible complications and a written consent was taken. A test dose of 2% plain lignocaine HCL from a multidose vial was deposited intradermally to produce a 5-mm diameter wheal [Table /Fig-1a]; the area was marked. Blood pressure and vital signs were monitored closely after intradermal injection. Within a time period of five min after injection patient started showing symptoms of drug allergy. Initially there was localized erythema at the site of the injection.Within few minutes patient started complaining of itching over different body parts, the patient was apprehensive, anxious and started showing generalized skin reaction, he had multiple solid raised lesions or papules less than 1 cm in size, flat topped, on his neck, trunk and limbs [Table/ Fig-2a&b]. Symptoms were resolved within one hour following treatment with antihistamine (Pheniramine maleate 25mg i.v.) and corticosteroid (dexamethasone 8mg i.v.). Later the extraction was performed using 0.5% bupivacaine after negative result of the skin testing with the same. Allergic responses to lignocaine (amide local anaesthesia) used in dentistry is extremely rare. It is widely used by Oral Maxillofacial surgeons to carry out various procedures safely, comfortably and efficiently. It is important for the practitioners to be aware that allergic reactions though very rare, can occur after injection of lignocaine intradermally for allergy testing. A proper diagnosis and management of such allergic reaction is very essential to avoid undesired consequences. We report a case of a 50-year-old male who suffered itching and generalized skin reaction within 5 minutes after administration of test dose of lignocaine intradermally for allergy testing. Clinical presentation, Diagnosis & management of such allergic reaction are discussed. As local anaesthetic agents are commonly used drugs in day to day practice clinicians are encouraged to be familiar with the presentation of various allergic reactions and there management. DisCussionLignocaine was first introduced into the practice in 1946 [1] since then it has been used very commonly in routine clinical practice. Local anaesthetics are divided into two groups: (i) amide derivatives of xylidine and toluidine group (lignocaine, mepivacaine, prilocaine) and (ii) ester or benzoic and aminobenzoic derivatives (cocaine, benzocaine, procaine, tetracaine, butacaine).The allergic reactions to the lignocaine is extremely rare, it has been estimated that true allergic reactions to local anaesthetics account for less than 1% of all adverse reactions to local anaesthetics [2,3]. Only a few cases ...

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“…5,9 Benzocaine appears to be the most common cause of type IV reactions to local anesthetics, 10 although this may not be true in some countries. 11 This topical anesthetic is present in numerous over-thecounter products used for sunburn, vaginal irritation, sexual enhancement, hemorrhoids; tetracaine, another p-amino benzoic acid ester, has been associated with type IV reactions in cosmetic as well urological applications.…”

Section: Discussionmentioning

confidence: 99%

Delayed-type hypersensitivity (type IV) reactions in dental anesthesia

Melamed

Beaucher

2007

allergy asthma proc

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The recommended methodology of evaluating patients who have presented with reactions to local anesthetics consists of epicutaneous skin testing and serial subcutaneous challenge. However, the role of type IV reactions in this group has been poorly documented. Epicutaneous routine testing and subcutaneous challenge to local anesthetic was performed, as well as patch testing and subcutaneous rechallenge of both at 24 and 48 hours with evaluation up to 72 hours was performed. Three patients presented with a history of localized edema after dental anesthesia. All had negative lidocaine and mepivacaine testing as well as negative lidocaine challenge on evaluation at 1 hour. The first patient, who had previously reacted to EMLA, reacted to both lidocaine and mepivacaine patch testing and challenge, with delayed swelling at 24 and 48 hours after challenge. This patient subsequently tolerated the ester anesthetic chloroprocaine. Two other patients had strong histories of contact dermatitis. Patch testing and challenge with lidocaine was negative, but strong reactions were found to benzocaine on patch testing. Patients undergoing local anesthetic testing should be screened historically for features and risk factors associated with type IV reactions. This should be considered in patients who react to multiple amide anesthetics, who have delayed swelling, or who have a history of severe contact dermatitis. We confirm previous data showing that patients reacting to benzocaine can tolerate lidocaine and that lidocaine-allergic individuals can tolerate ester anesthetics.

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Delayed-Type Hypersensitivity to Lidocaine

Cited by 71 publications

References 23 publications

Local anesthetics

Local anesthetics

An Unusual Complication with Use of Lignocaine: A Case Report

Delayed-type hypersensitivity (type IV) reactions in dental anesthesia

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