Anaphylaxis to lidocaine and cross-reactivity to articaine and prilocaine with tolerance to bupivacaine
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Allergo J Int https://doi.org/10.1007/s40629-020-00132-8
Anaphylaxis to lidocaine and cross-reactivity to articaine and prilocaine with tolerance to bupivacaine Ozge Can Bostan Ali Fuat Kalyoncu
· Mehmet Erdem Cakmak · Saltuk Bugra Kaya · Ebru Celebioglu · Gul Karakaya ·
Received: 8 May 2020 / Accepted: 1 June 2020 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020
Keywords Local anesthetics · Cross-reactivity · Drug hypersensitivity · Drug allergy · Amide group anesthetics
Introduction Adverse reactions to local anesthetics (LAs) are most frequently related to nonallergic causes like vasovagal reactions, the result of anxiety, or symptoms associated with concomitant administration of epinephrine with the LAs. Although so-called adverse reactions to local anesthetics are more frequent, actual hypersensitivity reactions are rare and known to account for less than 1% of all adverse reactions [1]. The actual allergy rate among patients with adverse reactions to LAs admitted to our clinic is 1/443 within the last 5 years. According to their chemical structure, local anesthetics are divided into two main groups: esters (piperocaine, benzocaine, chloroprocaine, procaine, tetracaine, cocaine) and amides (mepivacaine, lidocaine, bupivacaine, articaine, ropivacaine, prilocaine). Furthermore, cross-reactivity between local anesthetics in the amide group has been shown in some studies but is still not well-defined. However, allergic reactions are more common in local anesthetics with ester structures, which are hydrolyzed by plasma esterase and are less stable due to degradation products like para-aminobenzoic acid (PABA). Therefore, the utilization of ester group anesthetics is currently restricted. Furthermore, cross-reactivity between loO. C. Bostan () · M. E. Cakmak · S. B. Kaya · E. Celebioglu · G. Karakaya · A. F. Kalyoncu Department of Chest Diseases, Division of Allergy and Immunology, Hacettepe University School of Medicine, Ankara, Turkey [email protected]
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cal anesthetics in the amide group has been shown in some studies but is still not well-defined. Hypersensitivity reactions to LAs can be IgE mediated (type I) and/or T-cell mediated (type IV) [2]. Here, we report type I hypersensitivity reactions to lidocaine and articaine in a woman who was able to tolerate another amide anesthetic agent, bupivacaine.
Case A 40-year-old woman without previous allergic disease was referred from the dental clinic for evaluation of hypersensitivity to local anesthetics. Sixteen months before referral, the patient had developed angioedema of the lips, diffuse urticaria, and shortness of breath 2–3 min after administration of lidocaine hydrochloride. With the diagnosis of anaphylaxis, an intramuscular adrenaline injection, methylprednisolone, and diphenhydramine infusion were administered in the emergency room. The patient was then discharged after 24 h. Twenty days later, the dental procedure was reattempted using articaine as the preoperative local anesthetic. Urticarial skin lesions developed on her
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