Local anesthetic allergy adverse reactions

Wasserfallen JB. Frei PC Long-term evaluation of 39 usefulness of skin and incremental challenge tests in patients with history of adverse reaction to local anesthetics. Allergy 1995 50 162-165. 

Yamamoto F, Hamburger RN Administration of 27 local anesthetics to patients with a history of prior adverse reaction. J Allergy Clin Immunol 1978 61 339-345. 28... 

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. 

GaU H, Kaufmann R. Kalveram CM Adverse reactions to local anesthetics analysis of 197 cases. J Allergy CUn Immunol 1996 97 933-937. 

Berkum 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 91 342-345. 42... 

Systemic hypersensitivity reactions are not a frequent problem in local anesthesia. Systemic toxicity or allergy to additives (hyaluronidase, bisulfate, parabens) has sometimes been mistakenly classified as hypersensitivity to local anesthetics (SEDA-17,135) (29). WeU-documented case reports are very few, relating particularly to the older aminoesters this appears to be because these agents have the highly antigenic para-aminobenzoic acid as a metabolite (SEDA-13, 98). The incidence of true allergy is actually very low, probably less than 1% of all the adverse effects attributable to these substances (SEDA-20, 123). 

Following the first description of allergy to a local anesthetic over 90 years ago, there was initially a steady stream of reports of reactions to the drugs consisting mainly of erythema or edema. With the introduction of the amide local anesthetics, the number of hypersensitivity reactions tapered off significantly, indicating that ester compounds were less well tolerated. Even today, however, reports of adverse reactions to local anesthetics occasionally appear, but the nature of the reactions cannot always be described... 

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