Evaluation of Patients with History of Allergy to Local Anesthetic Drugs

Long‐term absence of sensitization to mepivacaine as assessed by a diagnostic protocol including patch testing

“…Moreover, the data regarding the eventful outcomes of the challenge observed in both patients previously displaying positive PT demonstrate that PT is reliable for the prediction of delayed type reactions to amide LAs that reportedly account for a substantial part of unexpected ALARs [4,5,18,19]. Clearly, if amide LA PT is confirmed in larger studies to be able to predict positive subcutaneous challenge tests, these latter could also be possibly omitted.…”

“…Consistently, in addition to the well‐documented allergic contact dermatitis by topically applied LAs [1,2,14], positive patch tests (PT) and T cell involvement have also been observed in subjects experiencing contact dermatitis [3,5,15–17] or other adverse reactions [17–19] to LA injections. Furthermore, delayed local or systemic reactions have been reported in association with delayed positive IST results with LAs in many patients [4,5], some of whom were indeed shown later on to display delayed‐type hypersensitivity to these drugs by in vivo specific PT [5,18,19] or in vitro specific T cell responses [17]. For these reasons, it has been proposed to perform IST with different, multiple concentrations and to evaluate possible delayed reactions after 24 h or more before patients can be permitted to undergo subcutaneous challenge [4,5].…”

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

“…Although skin testing has been criticised (as false positive and negative reactions occur), they remain valuable as part of the testing procedure. 13 The site of the injections and the patient's general condition were observed closely for the first 15 minutes, and then at 15 minute intervals up to 1 hour.…”

Hypersensitivity to local anaesthetics – update and proposal of evaluation algorithm

“…Immediate‐ and delayed‐type hypersensitivity reactions are clinically independent (37, 38) and cross‐reactivity patterns may not be transferred (39, 40). Cross‐reactivities are common within both the ester and amide group (38, 41–48) but cannot be predicted from the structure of the ionisable amide group (26, 41, 49–51).…”