Is Local Anaesthetic Drug Allergy Really Common? Single Centre Experience

Abstract

Objective: The main aim of this study is to objectively determine the actual frequency of allergic reactions in patients with a history of allergy to local anaesthetic drugs using skin tests and alternative provocation tests. In addition, it is aimed to evaluate the prevalence of other drug allergies in individuals presenting with local anaesthetic allergy and the effect of this on clinical presentation. The study also aims to shed light on clinical approaches by analysing the test results performed in patients who are administered alternative drugs due to a history of allergy. Methods: The data of patients who presented to the immunology and allergy outpatient clinic with local anaesthetic agent allergy between 01.01.2019-01.04.2025 were retrospectively reviewed. Other drug reactions, local anaesthetic agent allergy severity and alternative drug test results were recorded. Conclusion: It was observed that the majority of the patients described reactions with drugs other than local anaesthetics and therefore consulted a doctor. This situation, in accordance with the literature, showed that the reason for the application of both health professionals and patients was not due to local allergic drug allergy. The fact that only two patients were positive in the tests performed shows that the rate of local anaesthetic allergy is low, although the number of patients is insufficient.

Keywords

• Local anaesthesia
• drug hypersensitivity
• skin prick test
• dentistry

“Lokal Anestezik İlaç Alerjisi Gerçekte Ne Kadar Yaygındır? Tek Merkez Bir Deneyimi”

Abstract

Amaç: Bu çalışmanın temel amacı, lokal anestezik ilaçlara karşı alerji öyküsü bulunan hastalarda, deri testleri ve alternatif provokasyon testleri kullanılarak gerçek alerjik reaksiyon sıklığını objektif olarak belirlemektir. Ek olarak, lokal anestezik alerjisi şikayetiyle başvuran bireylerde diğer ilaç alerjilerinin prevalansını ve bu durumun klinik başvuru üzerindeki etkisini değerlendirmek hedeflenmektedir. Çalışmada ayrıca, alerji öyküsü nedeniyle alternatif ilaç uygulanan hastalarda yapılan test sonuçlarının analiz edilerek klinik yaklaşımlara ışık tutulması amaçlanmaktadır. Metod: 01.01.2019-01.04.2025 yılları arasında immünoloji ve alerji polikliniğine lokal anestezik ajan alerjisi ile başvuran hastaların bilgileri retrospektif olarak tarandı. Hastaların diğer ilaç reaksiyonları, lokal anestezik ajan alerji ağırlığı ve alternatif ilaç test sonuçları kaydedildi. Sonuç: Hastaların büyük çoğunluğunun lokal anestezik dışı ilaçlar ile reaksiyon tarif ettiği ve bu nedenle doktora başvurduğu görüldü. Bu durum literatürler uyumlu olarak hem sağlık profesyonelleri hem de hastaların başvuru sebebinin yaşadıkları lokal alerjik ilaç alerjisi sebepli olmadığını göstermiştir. Yapılan testler de ise sadece iki hastada pozitiflik olması hasta sayısı yetersiz olsa da lokal anestezik alerji oranının düşük olduğunu göstermektedir.

Keywords

• Local anesthesia
• drug hypersensitivity
• skin prick test
• diş hekimliği

References

1. 1.Kvisselgaard AD, Mosbech HF, Fransson S, Garvey LH. Risk of immediate-type allergy to local anesthetics is overestimated-results from 5 years of provocation testing in a Danish allergy clinic. J Allergy Clin Immunol Pract. 2018;6(4):1217-23. [Crossref]
2. 2.Koca Kalkan I, Koycu Buhari G, Ates H, Basa Akdogan B, Erdem Ozdedeoglu O, Aksu K, et al. Identification of risk factors and cross-reactivity of local anesthetics hypersensitivity: analysis of 14-years' experience. J Asthma Allergy. 2021;14:47-58. [Crossref]
3. 3.Post TW, editor. Allergic reactions to local anesthetics. Waltham, MA: UpToDate; 2020.
4. 4.Jiang S, Tang M. Allergy to local anesthetics is a rarity: review of diagnostics and strategies for clinical management. Clin Rev Allergy Immunol. 2023;64(2):193-205. [Crossref]
5. 5.Domínguez-Ortega J, Phillips-Angles E, González-Muñoz M, Heredia R, Fiandor A, Quirce S. Allergy to several local anesthetics from the amide group. J Allergy Clin Immunol Pract. 2016;4(4):771-2. [Crossref]
6. 6.Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Carr S, Custovic A, et al. Updated grading system for systemic allergic reactions: joint statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee. World Allergy Organ J. 2024;17(3):100876. [Crossref]
7. 7.YIlmaz I, Özdemir SK, Aydin Ö, Çelik GE. Local anesthetics allergy: who should be tested? Eur Ann Allergy Clin Immunol. 2018;50(2):66-71. [Crossref]
8. 8.Mertes PM, Lambert M, Guéant-Rodriguez RM, Aimone-Gastin I, Mouton-Faivre C, Moneret-Vautrin DA, et al. Perioperative anaphylaxis. Immunol Allergy Clin North Am. 2009;29(3):429-51. [Crossref]

9. 9.Grzanka A, Wasilewska I, Śliwczyńska M, Misiołek H. Hypersensitivity to local anesthetics. Anaesthesiol Intensive Ther. 2016;48(2):128-34. [Crossref]
10. 10.Astarita C, Gargano D, Romano C, Cutajar M, Manguso F, Montanaro D, et al. Long-term absence of sensitization to mepivacaine as assessed by a diagnostic protocol including patch testing. Clin Exp Allergy. 2001;31(11):1762-70. [Crossref]
11. 11.Saito M, Abe M, Furukawa T, Yagi M, Koike Y, Wakasugi Y, et al. Study on patients who underwent suspected diagnosis of allergy to amide-type local anesthetic agents by the leukocyte migration test. Allergol Int. 2014;63(2):267-77. [Crossref]
12. 12.Haddi E, Charpin D, Tafforeau M, Kulling G, Lanteaume A, Kleisbauer JP, et al. Atopy and systemic reactions to drugs. Allergy. 1990;45(3):236-9. [Crossref]
13. 13.Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702-12. [Crossref]
14. 14.Speca SJ, Boynes SG, Cuddy MA. Allergic reactions to local anesthetic formulations. Dent Clin North Am. 2010;54(4):655-64. [Crossref]
15. 15.Trautmann A, Goebeler M, Stoevesandt J. Twenty years' experience with anaphylaxis-like reactions to local anesthetics: genuine allergy is rare. J Allergy Clin Immunol Pract. 2018;6(6):2051-8.e1. [Crossref]
16. 16.Furci F, Martina S, Faccioni P, Faccioni F, Senna G, Caminati M. Adverse reaction to local anaesthetics: is it always allergy? Oral Dis. 2020;26(6):1340-2. [Crossref]
17. 17.Harboe T, Guttormsen AB, Aarebrot S, Dybendal T, Irgens A, Florvaag E. Suspected allergy to local anaesthetics: follow-up in 135 cases. Acta Anaesthesiol Scand. 2010;54(5):536-42. [Crossref]
18. 18.Ing Lorenzini K, Gay-Crosier Chabry F, Piguet C, Desmeules J. Meta-xylene: identification of a new antigenic entity in hypersensitivity reactions to local anesthetics. J Allergy Clin Immunol Pract. 2016;4(1):162-4. [Crossref]
19. 19.De Pasquale TMA, Buonomo A, Pucci S. Delayed-type allergy to articaine with cross-reactivity to other local anesthetics from the amide group. J Allergy Clin Immunol Pract. 2018;6(1):305-6. [Crossref]