^pDelayed‐type hypersensitivity to subcutaneous lidocaine with tolerance to articaine: confirmation by in vivo and in vitro tests

Abstract

A 43-year-old woman suffered from recurrent localized swellings and an eczematous dermatitis starting 1 day after an injection of lidocaine. Intradermal patch and lymphocyte transformation tests revealed sensitization to lidocaine and cross-reactivity to the other aminoacylamide local anesthetics bupivacaine, mepivacaine and prilocaine, but not to articane. Contact allergy to the ester local anesthetics benzocaine, procaine and tetracaine, the quinoline or aminoacylamide cinchocaine, and the preservatives methylparaben and metabisulfite, was excluded. A subcutaneous challenge with articaine was well tolerated.

Molecular Basis of Drug Recognition by Specific T–Cell Receptors

“…Compounds with only one residue (primary amines) are not capable of inducing cell proliferation. The data confirm also findings from previous studies [36], that ester and amide local anaesthetics do not cross–react in vivo and in vitro. …”

Delayed-Type Hypersensitivity to Lidocaine

“…The authors concluded that there was cross-sensitivity to prilocaine and mepivacaine as a result of lidocaine exposure, since the patient had never been exposed to these chemicals until the dates of the reactions. 6 Bircher et al 20 also reported a patient with localized swelling 24 hours after dental surgery, with patch tests revealing lidocaine sensitivity.…”

Allergy to lidocaine injections: comparison of patient history with skin testing in five patients

“…Among allergic reactions to LA, type IV hypersensitivity responses have been described predominantly to ester LA and clinically are represented by either contact dermatitis or rashes (macular or maculopapular) [13]. Torres et al .…”

“…Bircher et al . [13] described a case of a delayed-type reaction to LA with subsequent positive PT to lidocaine, mepivacaine and prilocaine but negative to articaine. Kanerva et al .…”