Anesthetics hypersensitivity

De Shazo RD, Nelson HS An approach to the 38 patient with a history of local anesthetic hypersensitivity experience with 90 patients. J Allergy Chn Immunol 1979 63 387-394. 

These drug s are contraindicated in those with a known hypersensitivity to any component of the preparation. The topical anesthetics are used cautiously in patients receiving Class I antiarrhytiimic drug s such as tocainide and mexiletine because the toxic effects are additive and potentially synergistic. 

Hypnotics. Common hypnotics are thiopental, propofol, midazolam, etomidate, ketamine and inhaled anesthetics. The incidence of hypersensitivity reactions with thiopental is rare. Recently, thiopental was involved in less than 1% of allergic reactions in France [9]. Ever since Cremophor EL, used as a solvent for some non-barbiturate hypnotics, has been avoided, many previously reported hypersensitivity reactions have disappeared. In the last French surveys, reactions to propofol accounted for less than 2.5% of allergic reactions, and reactions to midazolam, etomidate or ketamine appear to be really rare [9]. Finally, no immune-mediated immediate hypersensitivity reaction involving isoflurane, desflurane or sevoflurane has been reported despite their wide use. 

Thyssen JP. Menne T. Elberberg J. Plaschke P, 16 Johansen D Hypersensitivity to local anesthetics -update and proposal of evaluation algorithm. Contact Dermatitis 2008 59 69-78. 17... 

It is used in anaphylactic, allergic, and other hypersensitive reactions, as an agent to increase blood pressure in hypotension, as a broncholytic in pulmonary edema, as an antiedema agent in othorinolaringology (LOR) and in ophthahnological practice, and also to prolong the action of local anesthetics. 

Hypersensitivity reactions In patients sensitive to procaine or other ester-type local anesthetics, cross-sensitivity to procainamide is unlikely however, consider the possibility. Do not use procainamide if it produces acute allergic dermatitis, asthma or anaphylactic symptoms. 

Hypersensitivity to amide local anesthetics Stokes-Adams syndrome Wolff-Parkinson-White syndrome severe degrees of sinoatrial, atrioventricular (AV), or intraventricular block in the absence of an artificial pacemaker. 

IM Hypersensitivity to local anesthetics of the amide type and in patients with severe shock or heart block due to the use of lidocaine hydrochloride diluent. 

Hypersensitivity to sulfonamides or chemically related drugs (eg, sulfonylureas, thiazide and loop diuretics, carbonic anhydrase inhibitors, sunscreens with PABA, local anesthetics) pregnancy at term lactation infants less than 2 months of age (except in congenital toxoplasmosis as adjunct with pyrimethamine) porphyria salicylate hypersensitivity. 

Contraindications include hypersensitivity to local anesthetics of the amide type (a very rare occurrence), severe hepatic dysfunction, a history of grand mal seizures due to lidocaine, and age 70 or older. Lidocaine is contraindicated in the presence of second- or third-degree heart block, since it may increase the degree of block and can abolish the idioventricular pacemaker responsible for maintaining the cardiac rhythm. 

Benzonatate (Tessalon) is related to the local anesthetic tetracaine. It anesthetizes the stretch receptors in the lungs, thereby reducing coughing. Adverse reactions include hypersensitivity, sedation, dizziness, and nausea. 

Contraindications Hypersensitivity to benzocaine or ester-type local anesthetics, perforated tympanic membrane or ear discharge (otic preparations)... 

Contraindications History of hypersensitivity to beta-lactams (imipenem and cilas-tin, meropenem), hypersensitivity to amide-type local anesthetics (IM)... 

Contraindications Adams-Stokes syndrome, hypersensitivity to amide-type local anesthetics, septicemia (spinal anesthesia), supraventricular arrhythmias, Wolff-Par-kinson-White syndrome... 

Contraindications Hypersensitivity to esther local anesthetics, sulfites, PABA, infection or inflammation at the injection site, bacteremia, platelet abnormalities, thrombocytopenia, increased bleeding time, uncontrolled coagulopathy, anticoagulant therapy, sulfonamide therapy. 

Contraindications Hypersensitivity to local anesthetics, second- or third-degree AV block... 

Contraindications Hypersensitivity to benzocaine or similar local anesthetics... 

The ease of application, the minimization of systemic side effects, and the increased drug penetration directly into the target region resulted in extensive clinical use of iontophoresis mainly in the transdermal field. This technique has been utilized for administration of local anesthetics [2-5], sweat chloride testing in cystic fibrosis patients by transcutaneous delivery of pilocarpine [6,7], administration of vidarabine to patients with herpes orolabialis [8], fluoride administration to patients with hypersensitive dentin [9,10], and gentamicin delivery for the management of burned ears [11],... 

The ester-containing local anesthetics become metabolized to p-aminobenzoic acid derivatives, which have a potential for causing hypersensitivity reactions. Allergic reactions to amide are... 

Eugenol has been used since the nineteenth century as a flavoring agent in a variety of foods and pharmaceutical products. It has found use as a mild rubefacient in dentifrices, and as an obtundent for hypersensitive dentine, caries, or exposed pulp. Additional uses are in dental cement preparations, analgesics and anesthetics, and temporary dental filling when mixed with zinc oxide. The substance is also used in the perfumery or flavor industries, and also as insect attractant [1, 3, 4]. 

Among the drugs which are known to interact with barium, the barbiturates sodium pentobarbital and phenobarbital were found to have an increased depressive effect on the hearts of rats exposed to barium (Kopp et al. 1985 Perry et al. 1983, 1989). This hypersensitivity of the cardiovascular system to anesthesia was not observed in similarly treated animals that were anesthetized with xylazine plus ketamine. Results of the study indicated that the hypersensitivity was specific to the barbiturates and not a generalized effect of anesthesia (Kopp et al. 1985). 

General anesthetics are administered by intravenous, inhalation, or intramuscular routes. Adverse effects of general anesthetics are hypersensitivity, involuntary muscle movements, bronchospasm, cardiac arrhythmias, and respiratory... 

---