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

Abstract

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.

Local anesthetics allergy in children: Evaluation of diagnostic tests with Real‐Life data

“…In a study by Suleyman et al., skin manifestations was identified as a risk factor for LA allergy 22 . Conversely, when we examined the clinical characteristics of 23 patients with a history of hypersensitivity to LA, eight had a history of cutaneous symptoms such as urticaria/angioedema, but only two had positive intradermal test results, and no statistically significant difference was found.…”

“…20 Thus, further research with larger cohort studies is needed to better understand the relationship between a history of hypersensitivity to non-LA drugs or multiple drug allergies and the risk of LA In a study by Suleyman et al, skin manifestations was identified as a risk factor for LA allergy. 22 Conversely, when we examined the clinical characteristics of 23 patients with a history of hypersensitivity to LA, eight had a history of cutaneous symptoms such as urticaria/angioedema, but only two had positive intradermal test results, and no statistically significant difference was found.…”

Anafilaxia Inducida Por Anestésicos: Epidemiologia, Factores De Riesgo Y Medidas De Prevención.

“…Enfermedades atópicas: La presencia de enfermedades atópicas como el asma, la dermatitis atópica o la rinitis alérgica se ha asociado con un mayor riesgo de anafilaxia durante la anestesia (10).…”

Local Anesthetic Hypersensitivity Reactions in Pediatric Patients: Recognition and Management

“…A few data on risk factors for hypersensitivity reactions to LAs are available in children. In 17 children, Suleyman A et al [23] found previous responses to more than 2 LAs, having been exposed to LA at least 2 times in the past, and a prior reaction with skin symptoms predisposed to hypersensitivity reactions to LAs. However, Selmanoglu A et al [17] found no risk factor in a pediatric series.…”