Identification of Risk Factors and Cross-Reactivity of Local Anesthetics Hypersensitivity: Analysis of 14-Years’ Experience

Kalkan, İlkay Koca; Buhari, Gözde Köycü; Ateş, Hale; Akdoğan, Buket Başa; Özdedeoğlu, Özlem; Aksu, Kurtuluş; Erkekol, Ferda Öner

doi:10.2147/jaa.s292442

Cited by 13 publications

(17 citation statements)

References 28 publications

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“…14 Kallan et al showed a frequency of only 3.52% of positive tests for local anesthetics in a sample of 398 patients, totaling 452 provocations performed. 5 In Brazil, Aun et al performed a retrospective study at the Medication Allergy Ambulatory at the University of São Paulo, evaluating 93 provocation tests with LA in patients with a history of immediate hypersensitivity to these drugs and obtained three positive results, one of them in the prick test. 26 Tanno et al studied 33 patients with a history of reaction during or after (up to 24 hours) a procedure in which LA was used.…”

Section: Diagnostic Methods and Flowchartmentioning

confidence: 99%

“…9,15 The presence of generalized skin symptoms and hypotension related to the use of LA has been described as a predictor of positive skin tests or provocation. 5 The ester group LAs are the most associated with allergic hypersensitivity reactions, and their active metabolite and potential allergenic epitope is paraminobenzoic acid (PABA). 9 The cross-reactivity between the LAs of the ester group is attributed to this common metabolite.…”

Section: Ropivacainementioning

confidence: 99%

“…Immediate reactions correspond to less than 1% of hypersensitivity reactions, typically occur within 1 hour of LA administration and present as urticaria, angioedema, pruritus, bronchospasm and anaphylaxis. 5,18 The severity of the reaction depends on the allergen dose, route of administration and the amount of specific IgE. In case of suspected anaphylaxis, tryptase dosage may be useful in the diagnosis.…”

Section: Ropivacainementioning

confidence: 99%

“…Such tests help in the identification and confirmation of possible suspected agents, in order to know the real prevalence of LA allergy, and also to rule out the diagnosis or provide other alternative LAs for use. 5 Therefore, in this review, made from searches for original articles, reviews, guidelines and consensus in the MEDLINE and Latin American and Caribbean Literature on Health Sciences (LILACS) databases, using the terms: local anesthetics hypersensitivity, local anesthetics adverse effects, pharmacology, diagnostic tests, we updated the prevalence of reactions to LA, discussed the pharmacology of these medications, described the characteristics of each type of reaction and ended with the indications and investigation protocol, and consequently the outcomes of their results.…”

Section: Introductionmentioning

confidence: 99%

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Update on local anesthetics hypersensitivity reactions

Marcelino¹,

Felix²,

Ferreira³

et al. 2022

AAAI

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Os anestésicos locais são essenciais em diversos procedimentos médicos e odontológicos. Funcionam estabilizando as membranas neuronais e inibindo a transmissão de impulsos neurais, o que permite a realização desses procedimentos com mais segurança e sem dor. As reações adversas a drogas são definidas pela Organização Mundial da Saúde como todos os efeitos nocivos, não intencionais e indesejáveis de uma medicação, que ocorrem em doses usadas para prevenção, diagnóstico e tratamento. As reações de hipersensibilidade são reações adversas do tipo B, imprevisíveis, que clinicamente se assemelham a reações alérgicas e podem ou não envolver um mecanismo imune. As reações de hipersensibilidade verdadeiras aos anestésicos locais são raras, apesar de superestimadas. Nesta revisão destacamos a necessidade de uma avaliação completa dos pacientes com suspeita de reação alérgica aos anestésicos locais, incluindo a investigação de outros possíveis alérgenos que tenham sido utilizados no procedimento, como analgésicos, antibióticos e látex. A estratégia de investigação e seleção de pacientes para testes deve se basear na história clínica. Dessa forma, poderemos fornecer orientações mais assertivas e seguras aos pacientes.

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Section: Diagnostic Methods and Flowchartmentioning

confidence: 99%

Section: Ropivacainementioning

confidence: 99%

Section: Ropivacainementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Update on local anesthetics hypersensitivity reactions

Marcelino¹,

Felix²,

Ferreira³

et al. 2022

AAAI

View full text Add to dashboard Cite

show abstract

“…5–7 In broad patient series and pharmacological vigilance studies, immunoglobulin (Ig)E-mediated reactions to LA, particularly to those of amide class, have been reported to be rare. 8–18 …”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Immediate-Type Local Anesthetic Hypersensitivity Reactions in Pediatric Patients: A Retrospective Case-Control Study

Süleyman

Tamay

Güler

2022

JAA

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Background Local anesthetics (LA) are relatively safe and rarely cause immediate hypersensitivity reactions. The data on immediate LA hypersensitivity and its risk factors in children are limited. Aim To evaluate risk factors of immediate LA hypersensitivity. Methods The retrospective case-controlled study included 17 patients with confirmed immediate LA hypersensitivity. For each patient, three age- and gender-matched control subjects were included in the study. LA hypersensitivity was excluded by skin tests and subcutaneous drug provocation tests in all control subjects. Results The most common allergic assessment in the patient/control group was for lidocaine (n=5; 29.4%, vs n=23; 45.1%). Suspected LA hypersensitivity reactions were found to be associated with cutaneous manifestations in 14 (82.4%) patients and in 7 (13.7%) of the controls. A history of exposure to local anesthetics twice or more was present in 11 (64.7%) patients vs 6 (11.8%) controls. In conditional regression analysis, repeated LA exposure (≥2) and cutaneous findings were determined as significant risk factors (Odds Ratio [OR]:5.7; 95% Confidence Interval [CI]:1.2–27.1; P=0.029 and (OR:17.3; 95% CI:3.6–82.5; P<0.001, respectively). Conclusion Cutaneous manifestations and a history of LA exposure twice or more were predictive factors for LA allergy confirmed by skin test in children.

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