Risk of Immediate-Type Allergy to Local Anesthetics Is Overestimated—Results from 5 Years of Provocation Testing in a Danish Allergy Clinic

Kvisselgaard, Ask D.; Mosbech, H.; Fransson, Sara; Garvey, Lene Heise

doi:10.1016/j.jaip.2017.08.010

Cited by 34 publications

(43 citation statements)

References 38 publications

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“…One important problem is the low rate of confirmed cases after the allergy evaluation, 9 10%-30% in penicillin allergy, 42 21% in NSAIDs hypersensitivity 43 and none of 164 patients with suspected IRs to local anaesthetics. 44 This indicates the need to accurately evaluate these patients to reduce unnecessary inpatient/outpatient use of second-line treatments that may otherwise produce greater use of hospital resources. 45,46 In children with suspicion of DHRs to different drugs, from which NSAIDs and BLs were the most frequent, less than 10%-20% of cases were confirmed as allergic.…”

Section: Mis L Ab Elling Influen Ce S Dhr Re Al In Ciden Cementioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: Mis L Ab Elling Influen Ce S Dhr Re Al In Ciden Cementioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…Patients with immediate reactions will be at higher risk of a reaction during DPT and will need more cautious dosing than patients with milder delayed reactions. 17,18 Patients with very mild delayed reactions are considered at low risk of a reaction, and it is possible to use a single oral therapeutic dose without preceding skin testing. 19,20 Although this strategy is not directly relevant for patients with suspected perioperative allergic reactions, it has been used in surgical patients with labels of penicillin allergy, which are likely to be incorrect.…”

Section: Principles Of Drug Provocation Testing In General Drug Allergymentioning

confidence: 99%

“…This is especially important when the local anaesthetic is not the most suspected drug. 17,47 The survey showed that 10/13 ISPAR centres and 15/21 ANZAAG centres perform DPT with local anaesthetics.…”

Section: Local Anaestheticsmentioning

confidence: 99%

The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status

Garvey

Ebo

Krøigaard

et al. 2019

British Journal of Anaesthesia

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Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multicentre studies are necessary to determine indications and establish common testing protocols.

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“…Immediate-type, presumably IgE-mediated LA allergy is an exceedingly rare cause of anaphylaxis-like incidents during or after LA injections. [1][2][3][4] In contrast, allergic contact dermatitis caused by topical LA application is relatively common. Besides the ester-LA benzocaine, cinchocaine is frequently identified as a contact allergen.…”

Section: Introductionmentioning

confidence: 99%

“…Local anaesthetics (LAs) are among the most commonly administered drugs worldwide. Immediate‐type, presumably IgE‐mediated LA allergy is an exceedingly rare cause of anaphylaxis‐like incidents during or after LA injections . In contrast, allergic contact dermatitis caused by topical LA application is relatively common.…”

Section: Introductionmentioning

confidence: 99%

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

Trautmann

Stoevesandt

2018

Contact Dermatitis

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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.

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Risk of Immediate-Type Allergy to Local Anesthetics Is Overestimated—Results from 5 Years of Provocation Testing in a Danish Allergy Clinic

Cited by 34 publications

References 38 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status

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

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