Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience

Mehmet Kılınç; Fatih Çölkesen; Filiz Sadi Aykan; Recep Evcen; Tuğba Önalan; Fatma Arzu Akkuş; Eray Yıldız; Şevket Arslan

doi:10.18621/eurj.1806801

Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience

Abstract

Objectives: Clinicians widely utilize local anesthetic (LA) agents in pain management and surgical interventions. Nevertheless, drug hypersensitivity reaction (HR) to their use continue to raise considerable concern among both clinicians and patients. The present study aims to investigate the relationship between local anesthetic hypersensitivity reactions (LA-HRs) and comorbid conditions in patients referred to our clinic.

Methods: Clinical data and test results of patients who were referred to our allergy clinic for evaluation of suspected LA-HR were retrospectively reviewed. Skin tests (ST) and subcutaneous provocation tests (SPT) were performed.

Results: A total of 200 patients were included in the study. The most common reason for referral was a suspected LA-HR (80%), followed by a history of HR to other drugs with a need for LA use during upcoming procedures (20%). Among 160 patients with suspected LA- HR, only 5.6% demonstrated confirmed hypersensitivity by positive ST and SPT. Of the 40 patients with a history of HR to other drugs, only 2.5% tested positive for LA-HR. A history of comorbidity was present in 70% patients. Patients with suspected LA-HR had a significantly higher prevalence of comorbidities compared to those with HR to other drugs. However, none of the patients who tested positive had a history of comorbidity.

Conclusions: Confirmed hypersensitivity risk among patients reporting LA-HR is very low. Although comorbidities were more common among patients reporting LA-HR, none of the patients with confirmed allergy had any comorbidities, underscoring the low confirmed hypersensitivity rate in this population.

Keywords

Ethical Statement

This study was approved by the Necmettin Erbakan University Non-Drug and Non-Medical Device Research Ethics Committee (Decision No: 2023/4680-188; date: 15.12.2023). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent was waived because of the retrospective nature of the study and the analysis used anonymous clinical data.

References

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):1217-1223. doi: 10.1016/j.jaip.2017.08.010.
2. Janas-Naze A, Osica P. The incidence of lidocaine allergy in dentists: an evaluation of 100 general dental practitioners. Int J Occup Med Environ Health. 2019;32(3):333-339. doi: 10.13075/ijomeh.1896.01235.
3. Haugen RN, Brown CW. Case reports: type I hypersensitivity to lidocaine. J Drugs Dermatol. 2007;6(12):1222-1223.
4. Batinac T, Sotošek Tokmadžić V, Peharda V, Brajac I. Adverse reactions and alleged allergy to local anesthetics: analysis of 331 patients. J Dermatol. 2013;40(7):522-527. doi: 10.1111/1346-8138.12168.
5. Brockow K, Przybilla B, Aberer W, et al. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM). Allergo J Int. 2015;24(3):94-105. doi: 10.1007/s40629-015-0052-6.
6. Poziomkowska-Gęsicka I, Kostrzewska M, Kurek M. Comorbidities and Cofactors of Anaphylaxis in Patients with Moderate to Severe Anaphylaxis. Analysis of Data from the Anaphylaxis Registry for West Pomerania Province, Poland. Int J Environ Res Public Health. 2021;18(1):333. doi: 10.3390/ijerph18010333.
7. Onder G, Lattanzio F, Battaglia M, et al. The risk of adverse drug reactions in older patients: beyond drug metabolism. Curr Drug Metab. 2011;12(7):647-651. doi: 10.2174/138920011796504563.
8. Brockow K, Garvey LH, Aberer W, et al; ENDA/EAACI Drug Allergy Interest Group. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68(6):702-712. doi: 10.1111/all.12142.

9. Furci F, Martina S, Faccioni P, Faccioni F, Senna G, Caminati M. Adverse reaction to local anaesthetics: Is it always allergy? Oral Dis. 2020 Sep;26(6):1340-1342. doi: 10.1111/odi.13310.
10. Bhole MV, Manson AL, Seneviratne SL, Misbah SA. IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective. Br J Anaesth. 2012;108(6):903-911. doi: 10.1093/bja/aes162.
11. Fellinger C, Wantke F, Hemmer W, Sesztak-Greinecker G, Wöhrl S. The Rare Case of a Probably True IgE-Mediated Allergy to Local Anaesthetics. Case Rep Med. 2013;2013:201586. doi: 10.1155/2013/201586.
12. Kvisselgaard AD, Krøigaard M, Mosbech HF, Garvey LH. No cases of perioperative allergy to local anaesthetics in the Danish Anaesthesia Allergy Centre. Acta Anaesthesiol Scand. 2017;61(2):149-155. doi: 10.1111/aas.12833.
13. Bina B, Hersh EV, Hilario M, Alvarez K, McLaughlin B. True Allergy to Amide Local Anesthetics: A Review and Case Presentation. Anesth Prog. 2018;65(2):119-123. doi: 10.2344/anpr-65-03-06.
14. 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. doi: 10.23822/EurAnnACI.1764-1489.38.
15. Petersen TH, Bøhlke A. [Allergic reactions to local anaesthetics]. Ugeskr Laeger. 2018;180(39):V12170919. [Article in Danish]
16. Mertes PM, Malinovsky JM, Jouffroy L; Working Group of the SFAR and SFA; Aberer W, Terreehorst I, Brockow K, Demoly P; ENDA; EAACI Interest Group on Drug Allergy. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21(6):442-453.
17. Malinovsky JM, Chiriac AM, Tacquard C, Mertes PM, Demoly P. Allergy to local anesthetics: Reality or myth? Presse Med. 2016;45(9):753-757. doi: 10.1016/j.lpm.2016.05.011.
18. Wöhrl S, Vigl K, Stingl G. Patients with drug reactions -- is it worth testing? Allergy. 2006;61(8):928-934. doi: 10.1111/j.1398-9995.2006.01148.x.
19. Zuo J, Gong R, Liu X, Zhao J. Risk of True Allergy to Local Anesthetics: 10-Year Experience from an Anesthesia Allergy Clinic in China. Ther Clin Risk Manag. 2020;16:1297-1303. doi: 10.2147/TCRM.S280259.
20. Berkun Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience with 236 patients. Ann Allergy Asthma Immunol. 2003;91(4):342-345. doi: 10.1016/S1081-1206(10)61680-8.
21. Grzanka A, Wasilewska I, Śliwczyńska M, Misiołek H. Hypersensitivity lo local anesthetics. Anaesthesiol Intensive Ther. 2016;48(2):128-34. doi: 10.5603/AIT.a2016.0017.
22. Demoly P, Adkinson NF, Brockow K, et al. International Consensus on drug allergy. Allergy. 2014;69(4):420-37. doi: 10.1111/all.12350.
23. Erbay M, Seker Ü, Gunaydin F, Ediger D. Hypersensitivity Reactions to Local Anesthetics: A 5-Year Observational Study in a Turkish Tertiary Referral Center. Asthma Allergy Immunology. 2023;21(3):174-182. doi: 10.21911/aai.220.
24. Adkinson NF, Bochner BS, Burks AW, et al. editors. Middleton's Allergy. 8th. ed., W.B. Saunders, Elsevier. 2014.
25. Saito M, Abe M, Furukawa T, 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):267-277. doi: 10.2332/allergolint.13-OA-0653.
26. Erdeljic V, Francetic I, Likic R, Bakran I, Makar-Ausperger K, Simic P. Is referring patients with a positive history of allergic drug reactions or atopy for allergy testing to local anesthetics justified? Methods Find Exp Clin Pharmacol. 2009;31(3):177-182. doi: 10.1358/mf.2009.31.3.1354126.
27. Wu M, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016;58(2):138-144. doi: 10.1539/joh.15-0275-RA.
28. Mertes PM, Laxenaire MC, Alla F; Groupe d'Etudes des Réactions Anaphylactoïdes Peranesthésiques. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology. 2003;99(3):536-545. doi: 10.1097/00000542-200309000-00007.
29. Weinberg L, Peake B, Tan C, Nikfarjam M. Pharmacokinetics and pharmacodynamics of lignocaine: A review. World J Anesthesiol. 2015;4(2):17-29. doi: 10.5313/wja.v4.i2.17.
30. Song K, Blankenship RB, Derian A. Local Anesthetic Toxicity. [Updated 2025 Sep 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499964/
31. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29(6):564-75; discussion 524. doi: 10.1016/j.rapm.2004.08.003.
32. Verde Z, García de Diego L, Chicharro LM, et al. Physical Performance and Quality of Life in Older Adults: Is There Any Association between Them and Potential Drug Interactions in Polymedicated Octogenarians. Int J Environ Res Public Health. 2019;16(21):4190. doi: 10.3390/ijerph16214190.
33. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi: 10.1186/s12877-017-0621-2.
34. Raban MZ, Lind KE, Day RO, Gray L, Georgiou A, Westbrook JI. Trends, determinants and differences in antibiotic use in 68 residential aged care homes in Australia, 2014-2017: a longitudinal analysis of electronic health record data. BMC Health Serv Res. 2020;20(1):883. doi: 10.1186/s12913-020-05723-3.
35. Gutiérrez-Valencia M, Izquierdo M, Cesari M, Casas-Herrero Á, Inzitari M, Martínez-Velilla N. The relationship between frailty and polypharmacy in older people: A systematic review. Br J Clin Pharmacol. 2018;84(7):1432-1444. doi: 10.1111/bcp.13590.
36. Davies EA, O'Mahony MS. Adverse drug reactions in special populations - the elderly. Br J Clin Pharmacol. 2015;80(4):796-807. doi: 10.1111/bcp.12596.
37. Cunha IM, Gouveia J, Gomes E. Association between self-reported drug hypersensitivity reactions and psychological disorders. Asia Pac Allergy. 2022;12(2):e15. doi: 10.5415/apallergy.2022.12.e15.
38. Berrino AM, Voltolini S, Bignardi D, et al. Psychological aspects of drug intolerance. Eur Ann Allergy Clin Immunol. 2005;37(3):90-95.
39. De Pasquale T, Nucera E, Boccascino R, et al. Allergy and psychologic evaluations of patients with multiple drug intolerance syndrome. Intern Emerg Med. 2012;7(1):41-47. doi: 10.1007/s11739-011-0510-1.
40. Blumenthal KG, Li Y, Acker WW, et al. Multiple drug intolerance syndrome and multiple drug allergy syndrome: Epidemiology and associations with anxiety and depression. Allergy. 2018;73(10):2012-2023. doi: 10.1111/all.13440.
41. Blumenthal KG, Harkness T, Phillips EJ, et al; USDAR Study Team. Patient Characteristics and Concerns about Drug Allergy: A Report from the United States Drug Allergy Registry. J Allergy Clin Immunol Pract. 2020;8(9):2958-2967. doi: 10.1016/j.jaip.2020.08.018.
42. Rood JP. Adverse reaction to dental local anaesthetic injection--'allergy' is not the cause. Br Dent J. 2000;189(7):380-384. doi: 10.1038/sj.bdj.4800776.

Details

Primary Language

English

Subjects

Allergy

Journal Section

Research Article

Authors

Mehmet Kılınç ^*
0000-0003-1117-6872
Türkiye

Fatih Çölkesen
0000-0002-6595-1267
Türkiye

Filiz Sadi Aykan
0000-0002-8941-5573
Türkiye

Recep Evcen
0000-0002-6124-5816
Türkiye

Tuğba Önalan
0000-0003-2427-5925
Türkiye

Fatma Arzu Akkuş
0000-0003-0519-7132
Türkiye

Eray Yıldız
0000-0002-9596-1773
Türkiye

Şevket Arslan
0000-0002-0343-0159
Türkiye

Early Pub Date

December 17, 2025

Publication Date

February 1, 2026

Submission Date

October 19, 2025

Acceptance Date

December 7, 2025

Published in Issue

Year 2026 Volume: 12 Number: 2

DOI

https://doi.org/10.18621/eurj.1806801

IZ

https://izlik.org/JA34BF37HL

Cite

RIS / Bibtex

APA

Kılınç, M., Çölkesen, F., Sadi Aykan, F., Evcen, R., Önalan, T., Akkuş, F. A., Yıldız, E., & Arslan, Ş. (2026). Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience. The European Research Journal, 12(2), 187-198. https://doi.org/10.18621/eurj.1806801

AMA

1.Kılınç M, Çölkesen F, Sadi Aykan F, et al. Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience. Eur Res J. 2026;12(2):187-198. doi:10.18621/eurj.1806801

Chicago

Kılınç, Mehmet, Fatih Çölkesen, Filiz Sadi Aykan, et al. 2026. “Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience”. The European Research Journal 12 (2): 187-98. https://doi.org/10.18621/eurj.1806801.

EndNote

Kılınç M, Çölkesen F, Sadi Aykan F, Evcen R, Önalan T, Akkuş FA, Yıldız E, Arslan Ş (February 1, 2026) Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience. The European Research Journal 12 2 187–198.

IEEE

[1]M. Kılınç et al., “Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience”, Eur Res J, vol. 12, no. 2, pp. 187–198, Feb. 2026, doi: 10.18621/eurj.1806801.

ISNAD

Kılınç, Mehmet - Çölkesen, Fatih - Sadi Aykan, Filiz - Evcen, Recep - Önalan, Tuğba - Akkuş, Fatma Arzu - Yıldız, Eray - Arslan, Şevket. “Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience”. The European Research Journal 12/2 (February 1, 2026): 187-198. https://doi.org/10.18621/eurj.1806801.

JAMA

1.Kılınç M, Çölkesen F, Sadi Aykan F, Evcen R, Önalan T, Akkuş FA, Yıldız E, Arslan Ş. Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience. Eur Res J. 2026;12:187–198.

MLA

Kılınç, Mehmet, et al. “Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience”. The European Research Journal, vol. 12, no. 2, Feb. 2026, pp. 187-98, doi:10.18621/eurj.1806801.

Vancouver

1.Mehmet Kılınç, Fatih Çölkesen, Filiz Sadi Aykan, Recep Evcen, Tuğba Önalan, Fatma Arzu Akkuş, Eray Yıldız, Şevket Arslan. Impact of Comorbidities on Local Anesthetic Hypersensitivity: A Decade of Clinical Experience. Eur Res J. 2026 Feb. 1;12(2):187-98. doi:10.18621/eurj.1806801