Allergy to Local Anaesthetics

Fisher MM, Bowey CJ Alleged allergy to local anaesthetics. Anaesth Intensive Care 1997 25 611-614. 19... 

Allergy to local anaesthetics is possible, although this is not common. It is most likely in people who have regular contact with local anaesthetics such as dentists and anaesthetists. See Chapter 3 for details of allergic reactions to drugs. 

Other authors have reported the value of the lymphocyte transformation test. Lehner (1971) reported positive results in four patients with suspected allergy to local anaesthetics, in whom the intradermal skin test was negative. 

Harboe T, Guttormsen AB, Aarebrot S, Dybendal T, Irgens A, Florvaag E. Suspected allergy to local anaesthetics followup in 135 cases. Acta Anaesthesiol Scand 2010 54 536 2. 

Bhole MV, Manson AL, Seneviratne SL, Misbah SA. IgE-mediated allergy to local anaesthetics separating fact from perception a UK perspective. Br J Anaesth2012 108(6) 903-ll. 

Brinca A, Cabral R, Goncalo M. Contact allergy to local anaesthetics-value of patch testing with a caine mix in the baseline series. Contact... 

Breit S, Rueff F, PrzybiUa B Deep impact contact allergy after subcutaneous injection of local anesthetics. Contact Dermatitis 2001 45 296-297. Orasch CE, Helbling A, Zanni MP, Yawalkar N. Hari Y Pichler WJ T-cell reaction to local anaesthetics relationship to angioedema and urticaria after subcutaneous application-patch testing and LTT in patients with adverse reaction to local anaesthetics. Clin Exp Allergy 1999 29 1549-1554. 

Jacobsen RB. Borch JE. Bindslev-Jensen C Hypersensitivity to local anaesthetics. Allergy 2005 60 262-264. 

The leucocyte histamine release test (referred to in greater detail in Chaps. 1-7) is one of the in vitro correlates of immediate allergy which may find useful application in investigating reactions to local anaesthetics. It is of some value in detecting acute reactions, whether they are truly anaphylactic or due to direct (non-immune) histamine release (anaphylactoid). It is also more accurate (quantitative), more reliable and more predictive than skin tests, and above all it is free from risk. 

Soto-Aguilar MC, de Shazo RD. Dawsonn ES Approach to the patient with suspected local anaesthetic sensitivity. Immunol Allergy Clin North Am 1998 18 851-855. 

Allergic reactions to modern local anaesthetics are very rare. A possible allergy can be investigated in consultation with an allergist, should reactions like falling blood pressure, bronchospasm, edema or urticaria occur. 

Knowledge of the chemistry of local anaesthetics also helps in finding possible substitutes, e.g., the replacement of an ester by an amide agent which neither cross-reacts, nor is likely to cause allergy by itself. Many other compounds have local anaesthetic properties, and may be thought of as potential alternatives, e.g., certain phenothiazine antihistamines and propranolol (the jS-adrenoceptor blocker). 

The ability of local anaesthetics to produce contact dermatitis is well known (Rothman et al. 1945 de Swarte 1972). Hence patch tests may be of relatively greater value than in other allergies. In fact, cross-sensitisation with p-aminoben-zoate (used topically to prevent sunburn) was first reported in contact dermatitis studies (Gaul 1955). 

Incaudo G, Schatz M, Patterson R, Rosenberg M, Yamamoto F, Hamburger RN (1978) Administration of local anaesthetics to patients with a history of prior adverse reaction. J Allergy Clin Immunol 61 339-345... 

Calnan CD (1975) Sensitivity to benzamine lactate. Contact Dermatitis 1 56 Calnan CD (1978) Oxypolyethoxydodecane in an ointment. Contact Dermatitis 4 168 Calnan CD (1979) Allergy to idoxuridine ointment. Contact Dermatitis 5 194-195 Calnan CD (1980) Allergy to the local anaesthetic diperodon. Contact Dermatitis 6 367 Calnan CD, Harmon RRM, Wells GC (1961) Photodermatitis from soap. Br Med J 2 1266 Camarasa G (1976) Contact dermatitis from mercurochrome. Contact Dermatitis 2 120 Camarasa G, Alomar A (1978) Menthol dermatitis from cigarettes. Contact Dermatitis 4 169... 

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