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

Abstract

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.

Lidocaine in prevention of pain on propofol anesthetic induction: A randomized double-blinded clinical trial to estimate the magnitude of the effect

“…Propofol is extensively used for sedation in the modern practice of digestive system exams, with a frequency of use varying from 8 to 53% in different regions of the United States [14]. Local anesthetics can cause both type I (immediate hypersensitivity) allergic reactions and type IV (contact dermatitis) [15], but the number of patients that is affected by these reactions is unknown. In addition, even topical use of lidocaine can lead to systemic toxicity, both in children and in adults [16].…”

A case of postoperative bullous allergic contact dermatitis caused by injection with lidocaine

“…In our patient, intradermal tests with lidocaine were read after 15 minutes and 24 hours. The test concentrations were low because higher concentrations can give irritant (false‐positive) wheal‐and‐flare reactions after 15 minutes . For detection of a delayed‐type reaction at 24 hours, the concentrations tested were probably too low.…”

“…The test concentrations were low because higher concentrations can give irritant (false-positive) wheal-and-flare reactions after 15 minutes. 1 For detection of a delayed-type reaction at 24 hours, the F I G U R E 1 (A,B) VOORBERG AND SCHUTTELAAR concentrations tested were probably too low. Subcutaneous testing with lidocaine was not performed, because it was very likely that lidocaine was the culprit allergen in this case.…”

“…Injected local anaesthetics have been reported to cause delayed‐type reactions . A bullous type IV allergic reaction caused by lidocaine injected during a skin biopsy has been reported once …”

An overview of tropomyosin as an important seafood allergen: Structure, cross‐reactivity, epitopes, allergenicity, and processing modifications

“…There are various types of allergic reactions, which can be divided into Type-I: anaphylaxis, Type-II: cytotoxic, Type-III: immune complex, and Type-IV: late-onset (Maker et al, 2019;Trautmann & Stoevesandt, 2019). In individuals susceptible to TM, IgE-mediated allergic reaction (Type-I allergic reaction) is the most common (Jianhua Wang et al, 2021).…”