IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective

Bhole, Malini; Manson, Ania; Seneviratne, Suranjith L.; Misbah, Siraj

doi:10.1093/bja/aes162

Cited by 108 publications

(55 citation statements)

References 47 publications

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“…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 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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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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show abstract

“…Prior to his next dental appointment, we planned his treatment on the basis of the literature [1][2][3][4][5][6][7][8] (Figure 1). In our searching for the cause of his skin rashes, we suspected him as having LA allergy not influenza, because he presented with typical symptoms of allergy such as rashes that are different from those in influenza.…”

Section: Case Reportmentioning

confidence: 99%

“…Although hypersensitivity reactions are especially rare and account for less than 1% of all adverse reactions, exposure to allergens can cause a lifethreatening allergic reaction known as anaphylactic shock [1][2][3][4]. We sometimes encounter patients who believe that they have LA allergy on the basis of their experiences of developing various symptoms after injection of LAs.…”

Section: Introductionmentioning

confidence: 99%

Suspected Local Anesthetic Allergy of a Child: A Case Report

Matsumura¹,

Miyamoto²,

Fukayama³

2017

Pediatr Dent Care

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In dental practice, a certain number of patients complain of various symptoms after injection of local anesthetics. However, especially in children who cannot express their symptoms properly, a correct diagnosis of local anesthetic allergy is difficult. Here is a case of a boy with suspected local anesthetic allergy. We looked for an alternative local anesthetic on the basis of the medical history and the results of allergy tests.

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“…The negative predictive value for SPT has been estimated at 97%. 16 Challenge doses are given by subcutaneous 17 or, in some centres, intrabuccal routes.…”

Section: Local Anaestheticsmentioning

confidence: 99%

Introduction to drug allergy, and whom to refer for specialist assessment?

Kasternow

Karim

2016

Clinical Medicine

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Drug allergy is defined as an adverse drug reaction with an established immunological mechanism. The National Institute for Health and Care Excellence published clinical guidelines on drug allergy in 2014 and quality standards in 2015. The intention of this article is to highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical of course for patient safety, but also for better use of the drugs that we have available and to reduce unnecessary avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. It is, therefore, important to highlight to general physicians and physicians of other specialties, those patients who do require referral for specialist review. IntroductionAn adverse drug reaction (ADR) is defined as 'an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product '.1 However, drug allergy has a more specific definition. It has been defined by the British Society for Allergy and Clinical Immunology (BSACI) as 'an ADR with an established immunological mechanism'.2,3 The subject of drug allergy is very topical, particularly with the focus on patient safety, and has attracted the attention of the National Institute for Health and Care Excellence (NICE) with publication of clinical guidelines on drug allergy in 2014 and quality standards in 2015.3,4 The intention of this article is not to provide a comprehensive review of drug allergy, but rather to introduce the topic and highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical for patient safety, for better use of the drugs that we have available and to reduce the unnecessary ABSTRACT Introduction to drug allergy, and whom to refer for specialist assessment?avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. AssessmentThere is an issue of perception versus reality with respect to drug allergy. The prevalence of drug allergy estimated by patients in the general population is much higher than can be found objectively. For example, there are significant differences in the perception of the frequency of penicillin allergy. 5 This raises an important point in the initial evaluation of the patient with suspected drug allergy. In most cases, clinical ...

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IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective

Cited by 108 publications

References 47 publications

An Unusual Complication with Use of Lignocaine: A Case Report

An Unusual Complication with Use of Lignocaine: A Case Report

Suspected Local Anesthetic Allergy of a Child: A Case Report

Introduction to drug allergy, and whom to refer for specialist assessment?

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