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Title True Allergic Responses to Local Anesthetics (LAs) Are Rare, and Safe Alternative Anesthetics Can Be Used for Common Dental Procedures
Clinical Question In a patient who claims to have an allergy to local anesthetic, what is the likelihood that administration of local anesthetic will result in a true allergic response?
Clinical Bottom Line Although adverse drug reactions (ADRs) in patients who claim to have an allergy to local anesthetic are not uncommon, the likelihood that the adverse drug reaction is due to a true allergic response is low. This evidence is supported by a case control study that retrospectively analyzed patients who were referred for LA hypersensitivity and who underwent skin testing, subcutaneous exposition, and patch testing. The results showed that less than 1% of ADR are truly allergic responses and that no cross-reactions with amides were found, suggesting that safe alternatives may be used for patients who demonstrate adverse type reactions.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23682746Batinac/2013331 patients that claim to have allergies to “caine” local anestheticsCase Control Study
Key resultsEven though 419 independent adverse drug reactions (ADRs) to local anesthetics were reported in 331 patients who were referred for suspected hypersensitivity, only 3 patients reported a true drug allergy (0.91%). One patient showed a delayed-type reaction (type IV) to bupivacaine and two others showed immediate-type reactions (type I) to Lidocaine. ADRs occur more frequently in women (258, 78%) than men (73, 22%), in patients with a positive history of ADRs to some other drug (146, 44.10%, P < 0.05), in patients with associated allergic conditions (114, 34.44%, P < 0.05), and in patients who had some associated illness (P < 0.001).
Evidence Search "Anesthetics, Local"[Mesh] AND "Drug Hypersensitivity"[Mesh]
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The Evidence
Validity: The case control study retrospectively analyzed patients who were referred for suspected allergies to local anesthetics. All patients underwent the same tests, were blinded, and were tested by a controlled challenge with placebo. While the results of this study show that ADRs are more common in women than men, other studies show no differences according to sex. A large proportion of the patients could not identify the drug used, so the significance of epinephrine as a contributing factor to ADR could not be clearly determined. In order to determine which anesthetics can be safely used as alternatives, more studies need to be conducted that test all other components of local anesthetics that are suspected to cause adverse reactions such as epinephrine, preservatives, sulfites, and parabens.
Applicability Subjects in the studies were representative of patients who may present for dental treatment and who report allergies to local anesthetics on the medical history. The case control study reported evidence on patients with an age range 8-88 years and median age 50 in Croatia. Patients that are labeled as “allergic” most often experience reactions that are of pharmacological, toxic, pseudo-allergic, autonomic, or of other origins. Therefore, the term “drug allergy” should be reserved for patients that display true immunologic responses after undergoing an incremental challenge test (ICT) performed by an allergy specialist. Patients that continue to demonstrate true immunologic-like responses after negative challenge tests should be pre-medicated to reduce anxiety, and/or be treated with nitrous oxide, general anesthesia, or a local anesthetic without preservatives.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Restorative Dentistry)
Keywords Hypersensitivity, true allergy, local anesthetic, local anesthesia
ID# 3010
Date of submission: 03/16/2016spacer
E-mail millermr@livemail.uthscsa.edu
Author Matt Miller
Co-author(s) e-mail
Faculty mentor/Co-author Gregory F. Spackman, DDS, MBA
Faculty mentor/Co-author e-mail spackman@uthscsa.edu
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