Lidocaine allergic reaction

Another topical anesthetic, similar to benzocaine, is lidocaine, which is used to relieve the pain of shingles (herpes zoster) infections. Lidocaine is called an amide anesthetic, because it is not an ester (the alcohol is replaced by an amide, the nitrogen group). Amide anesthetics are metabolized by the liver, and are less prone to cause allergic reactions. If an anesthetic has the letter i in the prefix (lidocaine, prilocaine, bupivacaine), it is an amide anesthetic. 

Sore throat, swallowing problems. Demulcent lozenges containing surface anesthetics such as lidocaine (caveat benzocaine and tetracaine contain an allergenic p-ami-nophenyl group p. 207) may provide shortterm relief however, the risk of allergic reactions should be kept in mind. 

Severe allergic reactions occurred in five patients after the insertion of an intra-urethral lidocaine jelly containing chlorhexidine gluconate and instrumentation of the urethra (54). All had a positive response to chlorhexidine gluconate (0.0005%) and a negative response to lidocaine (0.2%). 

Allergic reactions to aminoamide local anesthetics are unusual, but type I hypersensitivity reactions are described, and life-threatening anaphylaxis can rarely occur (SEDA-21, 136) (SEDA-22, 134). Cross-reaction between amides also occurs, for example articaine, bupi-vacaine, lidocaine, and prilocaine (SEDA-22,134). 

Complications noted at various times with submucosal use include allergic reactions to the parabens present in lidocaine, systemic effects due to general diffusion (which... 

In 1973, in a multicenter study of 1200 individuals carried out by the North American Contact Dermatitis Group, there was a 3% incidence of delayed hypersensitivity reactions to parabens. General allergic reactions have also been reported after the injection of parabens-containing formulations of lidocaine and hydrocortisone and after oral use of barium sulfate contrast suspension, haloperidol syrup, and an antitussive sjrup, aU of which contained parabens (SEDA-11, 484). 

Allergic reactions, including anaphylaxis, have been reported to local anesthetics. This is much more common for amide than ester-containing anesthetics. Local tissue, especially nerve fiber, toxicity can occur. This was most dramatically noted with the advent of microbore intrathecal catheters used to inject high-concentration (5%) lidocaine. It is thought this resulted in high local tissue concentrations and produced a number of cases of cauda equine syndrome and radiculopathy. As a result of these incidents, microbore catheters were removed from the market in 1993. 

Allergies to local anesthetics (LAs) are rare, and the term allergy is often used to describe numerous problems that are more likely an overdose or a vagal reaction. Publications report that the frequency of allergic reactions to LAs is no more than 1% of aU the side-effects met with. Lidocaine is an amide local anesthetic that does not cause many allergies. 

These local anesthetics, including lidocaine (Xylocaine), mepivacaine (Carbo-caine), Prilocaine (Citanest), and bupivacaine (Marcaine) are weak sensitizers, but allergic reactions are sporadically reported, e. g., lidocaine (Turner 1977). Recently Fregert et al. (1979) described two patients developing lidocaine allergy after 8 and 1 month use of Xyloproct ointment (lidocaine 5%, hydrocortisone acetate) they also had positive patch tests to related amide anesthetics, both to mepivacaine, one to bupivacaine and prilocaine. A positive reaction to the chemically unrelated cincaine was interpreted as concomitant sensitivity rather than cross-sensitivity. Safe substitutes for benzocaine-sensitive patients include lidocaine, mepivacaine, prilocaine, bupivacaine, and pyrocaine (Fisher 1973 p. 312), all based on an amide structure. Lidocaine-sensitive patients may use tetracaine (pontocaine), a derivative of aminobenzoic acid. 

Instillagel which contains 0.25 % chlorhexidine, 2 % lidocaine, and mixed hydroxybenzoates, demonstrates why its involvement in indncing allergic reactions might in some cases remain unrecognized. A survey in 2005 conclnded that chlorhexidine accounted for 27 % of overlooked perioperative hypersensitivity reactions. 

Immunologic Allergic reactions to lido-caine for fiberoptic bronchoscopy have been reviewed [57 ]. The authors concluded that lidocaine is safe in bronchoscopy, provided that care is taken to limit the dose. In suspected local anesthetic allergy they suggested patch testing before the use of any topical anesthesia. 

The combination of lidocaine 7% -I- tetracaine 7% ( LT peel ) is a novel topical anesthetic cream formulation mainly used in dermatological procedures, such as laser treatment [58 ]. An allergic reaction has been reported [59 ]. 

Immunologic Type IV allergic reactions to lidocaine are rare. However, cross-reactivity to the amide local anesthetics has been described [74" ]. 

Bose AA, Colt HG. Lidocaine in bronchoscopy practical use and allergic reactions. J Bronchol Intervent Pulmonol 2008 15 (3) 163-6. 

Before a fuU-face phenol peel, the patient is always put on a drip, electrocardiographic monitoring, pulse oximeter and blood pressure monitor. The doctor has everything he needs at his disposal in case of any allergic, vagal or other reactions. Although bupivacaine, ropivacaine or mepivacaine can be employed for FNB, these products should not be used for the reasons set out above, and anesthesia should consist of FNB with lidocaine without adrenaline and with deep sedation. 

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