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Tadin A, Aleric K, Jerkovic D, Gavic L. Knowledge, Practice and Self-Reported Confidence Level of Croatian Dentists in the Use of Local Anesthesia: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2006. [PMID: 37510447 PMCID: PMC10379403 DOI: 10.3390/healthcare11142006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Objectives: To provide safe and effective local anesthesia, dentists must have knowledge of neuroanatomy, anesthesia agents, techniques, equipment, and proper use of local anesthetics. This study aims to explore the knowledge, practices, and confidence regarding local anesthetics and anesthetic techniques in dentistry. Material and Methods: The online cross-sectional questionnaire was conducted via social media, and yielded 441 responses from across the country (69.8% women and 30.2% men; 70.7% general dentists; and 29.3 specialists). The data collected included sociodemographic characteristics, knowledge, and practices pertaining to the usage of local anesthesia. The questionnaire also documents their self-assessed confidence level in applying different local anesthetic techniques and experiences with adverse reactions. The obtained data were processed by description and using a generalized linear model for regression. Results: The respondents had a median knowledge score of 6 out of a possible 14 points regarding local anesthetics in dental medicine, and their median self-confidence level in the successful application of various techniques of local anesthesia was 54 out of a maximum of 85 points. The results showed that a higher knowledge level was associated with the female gender (OR 1.83, CI 1.13-2.98, p = 0.014) and specialization in oral surgery (OR 7.04, CI 1.71-29.07, p = 0.007). In contrast, a lack of confidence in using various local anesthetic techniques was also associated with the female gender (OR 0.63, CI 0.41-0.99, p = 0.047) and specialization in orthodontics (OR 0.16, CI 0.03-0.88, p = 0.035). Of the respondents, 81.4% (n = 371) experienced a local complication, and 42.2% (n = 186) experienced a systemic complication during local anesthesia. The complications experienced cannot be associated with a lack of knowledge or self-confidence (p > 0.05). The majority of respondents (364 of the 441 total-82.5%) expressed interest in receiving further education on the topic of local anesthesia. Conclusions: The research results show that the dentists involved in the study have poor knowledge of local anesthetics and moderate self-reported confidence levels in using various local anesthetic techniques. Moreover, dentists' self-confidence in applying different techniques of local anesthesia is not related to their knowledge. Therefore, it would be necessary for dentists to undergo a continuing dental education program that enables them to enhance their skills and knowledge in local anesthesia.
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Affiliation(s)
- Antonija Tadin
- Department of Restorative Dental Medicine and Endodontics, Study of Dental Medicine, University of Split School of Medicine, 21000 Split, Croatia
- Department of Oral and Maxillofacial Surgery, Clinical Hospital Centre Split, 21000 Split, Croatia
| | - Klaudia Aleric
- Department of Restorative Dental Medicine and Endodontics, Study of Dental Medicine, University of Split School of Medicine, 21000 Split, Croatia
| | - Daniel Jerkovic
- Department of Oral and Maxillofacial Surgery, Clinical Hospital Centre Split, 21000 Split, Croatia
| | - Lidia Gavic
- Department of Restorative Dental Medicine and Endodontics, Study of Dental Medicine, University of Split School of Medicine, 21000 Split, Croatia
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Allergy to Local Anesthetics is a Rarity: Review of Diagnostics and Strategies for Clinical Management. Clin Rev Allergy Immunol 2023; 64:193-205. [PMID: 35482282 DOI: 10.1007/s12016-022-08937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
Abstract
Local anesthetics (LA) are commonly used in procedures and in topical agents for pain management. With the increasing use of LA drugs, the management of LA reactions is more frequently encountered in the office and in operating rooms. True allergic reactions involving IgE-mediated reactions and anaphylaxis are rare; they have only been identified in case reports and account for less than 1% of adverse LA reactions. Most reactions are non-allergic or are a result of hypersensitivity to other culprits such as preservatives, excipients, or other exposures. LA reactions that are misclassified as true allergies can lead to unnecessary avoidance of LA drugs or delays in surgical procedures that require their use. A detailed history of prior LA reactions is the first and most crucial step for understanding the nature of the reaction. Reactions that are suspicious for an immediate hypersensitivity reaction can be evaluated with skin prick and intradermal testing with subsequent graded challenge. Reactions that are suspicious for a delayed hypersensitivity reaction can be evaluated with patch testing.
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Aquilanti L, Mascitti M, Togni L, Contaldo M, Rappelli G, Santarelli A. A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031627. [PMID: 35162650 PMCID: PMC8835670 DOI: 10.3390/ijerph19031627] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients' reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.
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Affiliation(s)
- Luca Aquilanti
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Correspondence: ; Tel.: +39-071-2206-226
| | - Lucrezia Togni
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Via Armanni, 5, 80138 Naples, Italy;
| | - Giorgio Rappelli
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10/A, 60126 Ancona, Italy
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10/A, 60126 Ancona, Italy
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Hascoët E, Mahé J, Meillard H, Théophile H, Cloitre A, Lesclous P. Anaphylactic reactions to local anesthetics in dental practice: a nationwide French retrospective study. Clin Oral Investig 2021; 26:1667-1676. [PMID: 34431002 DOI: 10.1007/s00784-021-04139-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The primary aims of the present study were (1) to quantify and characterize anaphylactic type I reactions related to local anesthetics (LAs) drawing on the French Pharmacovigilance Database System over a 35-year period and (2) to focuse on reactions associated with dental procedures. The secondary aim was to infer an incidence rate in dental practice. MATERIALS AND METHODS All cases of anaphylactic reactions were selected using the algorithmic Standardized MeDRA Query "anaphylactic reaction." For each reaction, comprehensive data were collected, in particular the severity of symptoms, risk factors for anaphylaxis, and allergy testing. Imputability was assessed and a crude incidence rate in dental practice was estimated. RESULTS The first-line search identified 416 anaphylactic reactions, mostly of grade II (138) or III (240) severity. When restricted to dental practice, this number fell to 26 (grade I: 4; grade II: 10; grade III: 11; and grade IV: 1). Lidocaine was most often involved (81.49%) and mostly associated with anaphylactic reactions of grade II and III. Overall, 11 cases of fatal anaphylaxis were recorded, but no in dental practice. In dental practice, lidocaine was also the most frequently involved LA (57.69%). CONCLUSIONS All these findings highlight the very low incidence of type I-IgE-mediated reactions to LA, particularly in dental practice. The incidence rate of LA anaphylctic episodes in dental practice was estimated as 0.0261 anaphylactic episodes per million LA cartridges. CLINICAL RELEVANCE True anaphylactic reactions to LAs do occur and may justify a thorough investigation in dental practice.
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Affiliation(s)
- E Hascoët
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, UFR Odontologie, CHU de Nantes, Unité Fonctionnelle de Chirurgie Orale, PHU4 OTONN, ONIRIS, Nantes, France
| | - J Mahé
- Service de Pharmacologie Clinique, CHU de Nantes, Nantes, France
| | - H Meillard
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, UFR Odontologie, CHU de Nantes, Unité Fonctionnelle de Chirurgie Orale, PHU4 OTONN, ONIRIS, Nantes, France
| | - H Théophile
- Pôle de Santé Publique, Service de Pharmacologie Médicale, Centre Régional de Phramacovigilance de Bordeaux, Bordeaux, France
| | - A Cloitre
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, UFR Odontologie, CHU de Nantes, Unité Fonctionnelle de Chirurgie Orale, PHU4 OTONN, ONIRIS, Nantes, France
| | - P Lesclous
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, UFR Odontologie, CHU de Nantes, Unité Fonctionnelle de Chirurgie Orale, PHU4 OTONN, ONIRIS, Nantes, France.
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Bahar E, Yoon H. Lidocaine: A Local Anesthetic, Its Adverse Effects and Management. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:782. [PMID: 34440986 PMCID: PMC8399637 DOI: 10.3390/medicina57080782] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/12/2023]
Abstract
The most widely used medications in dentistry are local anesthetics (LA), especially lidocaine, and the number of recorded adverse allergic responses, particularly of hazardous responses, is quite low. However, allergic reactions can range from moderate to life-threatening, requiring rapid diagnosis and treatment. This article serves as a review to provide information on LA, their adverse reactions, causes, and management.
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Affiliation(s)
| | - Hyonok Yoon
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Gyeongsang National University, Jinju 52828, Korea;
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Kruse RC, Kindle BJ, Wisniewski S, Presley J, Smith J, Sellon JL. Local Anesthesia Prior to Ultrasound-Guided Hip Joint Injections: A Double-Blind Randomized Controlled Trial of Bacteriostatic Saline versus Buffered Lidocaine. PM R 2020; 13:811-818. [PMID: 32935453 DOI: 10.1002/pmrj.12489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ultrasound (US)-guided hip joint injections are commonly performed for patients with suspected or known intra-articular hip pain. Lidocaine is a well-established local anesthetic used prior to hip joint injections, but it is often associated with discomfort during infiltration. Bacteriostatic saline is an alternative local anesthetic that has been shown to be less painful during infiltration for superficial injections. OBJECTIVE To compare infiltrative pain and anesthetic efficacy of bacteriostatic saline (0.9% benzyl alcohol) with a standard local anesthetic (buffered 1% lidocaine) used for local anesthesia prior to US-guided intra-articular hip corticosteroid injections. DESIGN Double-blinded, randomized controlled trial. SETTING Tertiary care medical center. PARTICIPANTS Sixty eight patients age 18-80 (mean 54.8) years referred for US-guided intra-articular hip corticosteroid injections. INTERVENTION Patients were randomized to receive a US-guided hip joint corticosteroid injection using either bacteriostatic saline or buffered 1% lidocaine for preinjection local anesthesia. MAIN OUTCOME MEASURES Visual Analog Scale (VAS) for pain (0-100) during local anesthetic infiltration as well as during the intra-articular injection. Adverse events were also recorded. RESULTS There were no significant differences between bacteriostatic saline and buffered lidocaine with respect to pain during local anesthetic infiltration or during the subsequent intra-articular injection. Pain VAS during local anesthetic infiltration was 13.2 (95% confidence interval [CI] 7.8, 18.5) in the bacteriostatic saline group and 14.0 (95% CI 9.4, 18.5) in the buffered 1% lidocaine group (P = .82). Furthermore, pain VAS during the intra-articular injection was 20.7 (95% CI 14.1, 27.3) in the bacteriostatic saline group and 15.7 (95% CI 10.9, 20.3) in the buffered 1% lidocaine group (P = .57). No adverse events occurred. CONCLUSIONS Bacteriostatic saline is a safe and comparably effective alternative to buffered 1% lidocaine for local anesthesia before US-guided hip joint injections and may be considered for subcutaneous/periarticular anesthesia during similar musculoskeletal procedures.
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Affiliation(s)
- Ryan C Kruse
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.,Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Brett J Kindle
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.,Andrews Institute, Gulf Breeze, FL, USA
| | - Steve Wisniewski
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - James Presley
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA.,Andrews Institute, Gulf Breeze, FL, USA
| | - Jay Smith
- Departments of Physical Medicine & Rehabilitation, Radiology and Clinical Anatomy, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
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Furci F, Martina S, Faccioni P, Faccioni F, Senna G, Caminati M. Adverse reaction to local anaesthetics: Is it always allergy? Oral Dis 2020; 26:1340-1342. [PMID: 32090398 DOI: 10.1111/odi.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Local anaesthetics are very commonly used drugs in dentistry, and people who undergo procedures with local anaesthetics often refer adverse reactions that are not of allergic origin. Considering that in dentistry contact with allergens is very frequent, it is essential to assess the real incidence of allergy to local anaesthetics. SUBJECTS AND METHODS We evaluated a group of 159 patients in whom adverse reaction occurred after procedures with local anaesthetics. RESULTS The reactions between allergy to local anaesthetic (immediate and delayed) and certain symptoms presented by patients were investigated. Allergy to latex and chlorexidine were investigated in all patients. Only one patient, who previously presented a constant erythema at the wrist after procedure with local anaesthetics, was positive to Mepivacaine patch test. Two patients were positive to latex and one to chlorexidine. CONCLUSIONS The main finding of this study was that a reaction registered in the medical history and reported by a patient is rarely allergic but the use of vasoconstrictors or emotional factors may account for it. However, a complete allergological investigation is necessary for a correct diagnosis and future management.
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Affiliation(s)
- Fabiana Furci
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, Messina, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Paolo Faccioni
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Fiorenzo Faccioni
- Section of Oral and Maxillofacial Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
- Department of Medicine, University of Verona, Verona, Italy
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Observational study of adverse reactions related to articaine and lidocaine. Oral Maxillofac Surg 2020; 24:327-332. [PMID: 32524211 DOI: 10.1007/s10006-020-00866-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study determined the frequency of adverse reactions related to the administration of local dental anesthesia with 4% articaine compared with 2% lidocaine, both associated with epinephrine 1:100,000. The null hypothesis was that there is no difference between the administrations of both dental local anesthesia. METHODS From a total of 727 patients in an emergency service, 338 and 389 patients were subjected to local anesthesia with lidocaine and articaine, respectively. A questionnaire was completed for each patient that contained patient data, the local anesthesia applied, and any reactions. RESULTS The overall frequency of adverse reactions was 3.71%, with sweating and pallor being the most frequently observed. There was an association between adverse reactions and the use of daily medication by patients anesthetized with articaine (p = 0.0266). In contrast, in patients anesthetized with lidocaine, there was an association among the duration of the procedure (p = 0.0423), the type of procedure (p = 0.0146), and first anesthesia exposure (p = 0.0448). CONCLUSIONS The low frequency of adverse reactions with use of articaine and lidocaine led to the conclusion that both solutions are safe for use in dentistry.
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Lee IT, Arioka M, Kleinman SH, Gernez Y. Masqueraders of angioedema after a dental procedure. Ann Allergy Asthma Immunol 2020; 124:536-541. [PMID: 32205197 DOI: 10.1016/j.anai.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ivan T Lee
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
| | - Masaki Arioka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California; Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sara H Kleinman
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
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Sanan N, Lee J, Baxter C, Jeskey J, Hostoffer R. Delayed and protracted allergic reaction to oral lidocaine. Ann Allergy Asthma Immunol 2019; 123:413-414. [PMID: 30878625 DOI: 10.1016/j.anai.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/19/2019] [Accepted: 03/06/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Neha Sanan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Jenny Lee
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Christina Baxter
- Nova Southeastern University College of Osteopathic Medicine Davie, Florida
| | - Jack Jeskey
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida
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Janani MK, Jaichandran V, Madhavan HNR, Vijaya L, George RJ, Ambastha PS, Manu A, Malathi J. Effect of Lignocaine Concentration on Human Fibroblasts Growth in Eyes Undergoing Trabeculectomy: An in vitro Study. Biomed Hub 2018; 3:1-10. [PMID: 31988963 PMCID: PMC6945966 DOI: 10.1159/000491074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/19/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate the effect of lignocaine on growth and apoptosis indication of primary human Tenon's capsule fibroblast (HTFs) in an in vitro model. Patients and Methods Tenon's capsule tissue obtained from patients undergoing trabeculectomy were grown in cell culture medium. The effect of different concentrations of lignocaine (0.5, 1.0, 1.5, and 2%) on the morphology and growth of the fibroblasts was studied using microscopy, cell viability, and proliferation assay, and apoptosis was detected using the FITC Annexin V Apoptosis Kit. Results Morphological changes similar to those of apoptotic cells, including cytoplasmic vacuolation, shrinkage, and rounding were visualized in the cells treated with concentrations greater than 1.0% (i.e., 1.5, 2.0%). Though proliferation inhibition was found with all four concentrations (0.5–2.0%), the viability of cells decreased from 1.0% lignocaine. Conclusion 0.5% lignocaine prevents proliferation of fibroblasts without causing apoptosis in vitro.
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Affiliation(s)
| | | | | | - Lingam Vijaya
- Department of Glaucoma, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ronnie Jacob George
- Department of Glaucoma, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Abhijeet Manu
- Birla Institute of Technology & Science, Pilani, India
| | - Jambulingam Malathi
- L&T Microbiology Research Centre, Vision Research Foundation, Chennai, India
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Immediate Local Anesthetic Reactions: Too Quick to Point the Finger? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1224-1225. [DOI: 10.1016/j.jaip.2017.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/24/2022]
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Trautmann A, Goebeler M, Stoevesandt J. Twenty Years' Experience with Anaphylaxis-Like Reactions to Local Anesthetics: Genuine Allergy is Rare. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:2051-2058.e1. [PMID: 29655774 DOI: 10.1016/j.jaip.2018.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/25/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Anaphylaxis-like reactions occur within minutes after the application of local anesthetics (LA), most commonly during dental interventions. Impressive symptoms including respiratory distress or loss of consciousness frequently give rise to a suspicion of allergy and may prompt patients and treating physicians to refuse future LA injections. OBJECTIVE Nonallergic mechanisms are responsible for the majority of LA-induced immediate-type reactions. In view of the preponderance of nonallergic reactions, the question arises whether genuine LA allergy may be missed during routine testing procedures. METHODS We retrospectively evaluated clinical data and test results from patients referred to our allergy clinic within the past 20 years for diagnostic workup of LA-induced immediate-type reactions. RESULTS Of 402 evaluated patients, 29 had an episode of acute urticaria within 30 minutes after LA injections, and the remaining 373 had a history of mainly subjective cutaneous, respiratory, cardiovascular, and neurological complaints. Of the patients reporting urticaria with or without angioedema, 14 were diagnosed with a spontaneous episode of urticaria, 13 had allergic or nonallergic reactions to other agents, and 2 had IgE-mediated LA allergy. LA allergy was definitely excluded by 771 subcutaneous provocation tests with skin test negative LA, thereby demonstrating the high predictive value of negative intradermal testing. CONCLUSIONS Skin testing and provocative LA challenge are useful to exclude LA allergy, and this testing procedure seems to be appropriate to identify the extremely rare cases with IgE-mediated LA allergy.
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Affiliation(s)
- Axel Trautmann
- Department of Dermatology, Venereology and Allergy, University Hospital Würzburg, Würzburg, Germany.
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergy, University Hospital Würzburg, Würzburg, Germany
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15
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Kvisselgaard AD, Mosbech HF, Fransson S, Garvey LH. Risk of Immediate-Type Allergy to Local Anesthetics Is Overestimated-Results from 5 Years of Provocation Testing in a Danish Allergy Clinic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:1217-1223. [PMID: 28988784 DOI: 10.1016/j.jaip.2017.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/14/2017] [Accepted: 08/15/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local anesthetics (LAs) are used in many health care settings and exposure during a lifetime is almost inevitable. Immediate-type allergy to LAs is considered rare among allergy experts but is commonly suspected by health care workers from other specialties, and by patients. OBJECTIVE The main aim of this study was to investigate the incidence of immediate-type allergy to LAs in our regional allergy clinic over the 5-year period 2010 to 2014. METHODS This was a retrospective single-center study of patients referred to a regional allergy clinic (excluding patients with perioperative reactions) with suspected immediate allergy to LAs, who had undergone subcutaneous provocation with 1 or more LAs. Patients were identified in the hospital clinical coding system and clinical information about the reaction and investigation results was obtained from their medical records. RESULTS A total of 164 patients (123 women/41 men; median age, 56 years; range, 7-89 years) who had 189 provocations with LAs were included over the 5-year period 2010 to 2014. All 164 patients had negative subcutaneous provocations to all 189 tests with LAs (95% CI, 0%-1.83%). Another allergen was identified in 10% (n = 17) of the patients. CONCLUSIONS None of the 164 patients with suspected immediate-type allergy to LAs reacted on provocation. Thus, no patients have been diagnosed with an immediate allergy to LAs in our regional allergy clinic in the 5-year period studied, and allergy to LAs must be considered very rare. Alternative mechanisms should be considered, but if symptoms are consistent with allergy, other potential allergens should be investigated.
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Affiliation(s)
- Ask D Kvisselgaard
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Holger F Mosbech
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sara Fransson
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Costa-Farré C, Climent F, Moreira da Fonseca C, Gómez de Segura IA. Anesthesia Case of the Month. J Am Vet Med Assoc 2017; 251:291-294. [PMID: 28703663 DOI: 10.2460/javma.251.3.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Hsu Blatman KS, Hepner DL. Current Knowledge and Management of Hypersensitivity to Perioperative Drugs and Radiocontrast Media. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:587-592. [DOI: 10.1016/j.jaip.2017.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/16/2017] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
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Allen G, Chan D, Gue S. Investigation and diagnosis of an immediate allergy to amide local anaesthetic in a paediatric dental patient. Aust Dent J 2017; 62:241-245. [PMID: 28160767 DOI: 10.1111/adj.12501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
Local anaesthetics remain the most common prescription medication utilized in dental practise. Adverse reactions following administration of local anaesthetic are somewhat common and are frequently reported as 'allergies'. However, of these events, it is estimated that only 1% are confirmed allergies to the local anaesthetic. This case report presents the process of referral for investigation and testing to confirm an amide local anaesthetic allergy in a paediatric patient. Testing for a safe alternative was also completed to identify local anaesthetic agents also of the amide variety that could be utilized safely on this individual. Following skin testing of alternative agents, intraoral challenges were completed. Finally, restorative dental treatment was provided safely for the patient with the use of an alternative amide local anaesthetic on a number of occasions with no further adverse outcomes.
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Affiliation(s)
- G Allen
- Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - D Chan
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - S Gue
- Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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Kvisselgaard AD, Krøigaard M, Mosbech HF, Garvey LH. No cases of perioperative allergy to local anaesthetics in the Danish Anaesthesia Allergy Centre. Acta Anaesthesiol Scand 2017; 61:149-155. [PMID: 27878813 DOI: 10.1111/aas.12833] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/30/2016] [Accepted: 10/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local anaesthetics (LA) are often suspected as possible causes of allergic reactions. The Danish Anaesthesia Allergy Centre (DAAC) is the national reference centre for investigation of perioperative allergic reactions. The purpose of this study was to investigate the incidence of IgE-mediated immediate type perioperative allergic reactions to LA. METHODS In the period 2004-2013, a total of 409 patients (244 women/165 men; median age 49 years, range 1-86 years) were investigated in DAAC on suspicion of allergy associated with anaesthesia and surgery. A total of 162 (40%) patients were exposed to one or more LA. Suspected allergy to LA was investigated by prick test, intradermal test and subcutaneous provocation with the suspected drug. Patients with positive skin tests still underwent subcutaneous provocation, as false positive skin tests can occur. RESULTS A total of 203 test series with LA were carried out on 162 patients (89 women/73 men; mean age 49 years, range 2-85 years) with the following drugs: Lidocaine n = 80 (49%), bupivacaine n = 82 (51%), ropivacaine n = 31 (19%) and mepivacaine n = 10 (6%). All 162 patients had negative subcutaneous provocation for all tested LA (95% CI: 0-1.8%). Investigations revealed another allergen in 52 of 162 patients. CONCLUSION None of the 162 patients with suspected perioperative allergic reactions and exposure to LA reacted on subcutaneous provocation with the relevant LA. Thus, no patients have been diagnosed with allergy to LA in DAAC in the period 2004-2013 and allergy to LA must be considered very rare in this population.
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Affiliation(s)
- A. D. Kvisselgaard
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - M. Krøigaard
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - H. F. Mosbech
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - L. H. Garvey
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
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Abstract
BACKGROUND Adverse reactions from lidocaine are commonly reported. When allergy is suspected, patients may be referred for specific skin testing to confirm the association of their clinical findings. OBJECTIVE We aimed to investigate 13 cases of suspected lidocaine allergy to analyze if positive patch results restricted future use as an injectable local anesthetic. METHODS A prospective study was conducted from March 2013 to September 2014 at 2 academic hospital-based patch test clinics in Toronto. Patients were tested to the North American Contact Dermatitis Group standard series (Smart Practice, Phoenix, AZ) and, if suspicion for lidocaine allergy was high, a local anesthetic series (Chemotechnique Diagnostics, Malmö, Sweden) was added. Intradermal skin testing to local anesthetics below irritant concentrations was subsequently conducted in lidocaine-positive patients. If negative, a subcutaneous challenge with 1% lidocaine was done. RESULTS Thirteen of 756 patients patch tested were positive to lidocaine. Seven patients had relevant reactions to over-the-counter products containing lidocaine, 2 reacted to subcutaneous lidocaine, and 4 had incidental findings. There were no patients with positive results to intradermal testing. Three patients had delayed reactions to the subcutaneous challenge. CONCLUSIONS Patients with positive patch tests to lidocaine and negative results to intradermal testing and subcutaneous challenge may be safe to use lidocaine as an injectable local anesthetic in the future.
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Malinovsky JM, Chiriac AM, Tacquard C, Mertes PM, Demoly P. Allergy to local anesthetics: Reality or myth? Presse Med 2016; 45:753-7. [DOI: 10.1016/j.lpm.2016.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/28/2016] [Accepted: 05/10/2016] [Indexed: 11/30/2022] Open
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Singh N, De Mesa C. Unusual Hypersensitivity Reaction to Iohexol During Epidural Steroid Injection Resulting in Lipoma Development: A Case Presentation. PM R 2016; 8:1218-1221. [PMID: 27292434 DOI: 10.1016/j.pmrj.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 05/28/2016] [Accepted: 06/04/2016] [Indexed: 11/15/2022]
Abstract
Epidural steroid injections are common interventional pain procedures for radicular pain when conservative therapies fail. We present the case of a 36-year-old woman with lumbar radicular pain who developed a hypersensitivity reaction to iohexol during a fluoroscopically guided interlaminar epidural steroid injection resulting in lipoma development. Mechanisms of anaphylactoid reaction and recommendations for lipoma treatment are described based on clinical presentation. With an increase in the number of injections performed for pain management, awareness of this complication may need to be included for informed consent. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Naileshni Singh
- Department of Anesthesia and Pain Medicine, University of California, Davis, Sacramento, CA(∗)
| | - Charles De Mesa
- Department of Anesthesia and Pain Medicine, University of California, Davis, 4860 Y St., Suite 2600, Sacramento, CA 95817(†).
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Abstract
BACKGROUND Local anesthetic (LA) allergy is a concern for dermatologic surgeons given the large number of procedures performed yearly with LAs. Many patients also have anxiety about past or potential anesthesia allergy. OBJECTIVE This article will review the symptoms of IgE-mediated allergic reactions, the prevalence of IgE-mediated LA allergy, discuss common mimics of LA, and propose a practical approach for diagnostic and therapeutic options for LA allergy for the dermatologic surgeon in practice. MATERIALS AND METHODS A literature search of Pubmed using keywords "lidocaine," "local anesthetic," "hypersensitivity," and "allergy" was performed. RESULTS Amide anesthetics result in the most reports of true local anesthetic immediate hypersensitivity. CONCLUSION True IgE-mediated anaphylaxis to local anesthesia is very rare. Dermatologic surgeons should be aware of the symptoms of anesthetic allergy and its mimickers, as well as how to manage allergic reactions in their clinical practice.
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A case of severe NSAID exacerbated respiratory disease (NERD) following a dental procedure in a child. Eur Arch Paediatr Dent 2016; 17:277-81. [PMID: 27179970 DOI: 10.1007/s40368-016-0233-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND An allergic reaction following a dental procedure is a rare event. A local anaesthetic (LA) may initially be suspected as a causative agent but allergy to dental LA solutions is extremely rare. CASE REPORT This report concerns a 13 year old child who underwent dental treatment and was exposed to Lignospan Special(®) LA, mouthwash, latex gloves, ibuprofen medication, and a Magnum(®) (almond) ice cream all within 45 min. He subsequently developed acute symptoms of nasal rhinorrhoea, facial flushing, peri-orbital and lip angioedema, followed by throat tightness and wheeze (respiratory compromise). His acute reaction was treated by his medical practitioner with oral anti-histamines, steroid and nebulised salbutamol. The child was referred to a local allergist. The child underwent detailed allergic investigations including skin prick tests, blood tests, incremental local anaesthetic challenge and ibuprofen challenge. The patient was diagnosed with NSAID exacerbated respiratory disease (NERD), a hypersensitivity reaction to ibuprofen. FOLLOW-UP The patient was advised to avoid NSAIDs and to wear a medic-alert (allergy) bracelet. A detailed written report was sent to the patient's dentist and GP. CONCLUSIONS In the context of a suspected reaction post dental procedure, local anaesthetic should be considered a possible allergen but other important considerations include analgesics, antibiotics, and latex. All genuine allergic reactions need to be investigated. This report highlights NERD as a possible adverse outcome following dental treatment.
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Holanda VM, Chavantes MC, Silva DFT, de Holanda CVM, de Oliveira JO, Wu X, Anders JJ. Photobiomodulation of the dorsal root ganglion for the treatment of low back pain: A pilot study. Lasers Surg Med 2016; 48:653-9. [PMID: 27135465 DOI: 10.1002/lsm.22522] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic low back pain is a worldwide public health issue with high socioeconomic impact. The aim of this study was to determine the efficacy of laser irradiation of the dorsal root ganglion of the second lumbar spinal nerve for chronic axial low back pain compared to lidocaine injection and radiofrequency treatment. STUDY DESIGN/MATERIALS AND METHODS Twenty-eight patients were randomly divided into three treatment groups: lidocaine injection, radiofrequency, or laser. The second intervertebral foramen between the second and third lumbar vertebrae was accessed by percutaneous needle puncture bilaterally, guided by fluoroscopy. In the local anesthetic group, injection of 1 ml lidocaine without epinephrine was applied through a 20-gauge (G20) Quincke tip spinal needle inserted in the second lumbar intervertebral foramen. In the radiofrequency group, the probe (150 mm long with a 5 mm active tip) was directed through a G20 needle placed in the second lumbar intervertebral foramen and neuromodulation was done with a radiofrequency of Cosman G4® in pulses of 20 ms with wash-out period of 480 ms, for 300 seconds at 42°C. A single treatment was used. In the laser treatment group, a continuous wave, 808 nm wavelength diode laser (Photon Lase III® DCM, Brazil), with an output power of 100 mW was used for a single treatment. An 18 gauge needle was placed in the second lumbar intervertebral foramen guided by fluoroscopy. Light was delivered through a 600 µm optical fiber placed in the G18 needle. The tip of the fiber extended 5 mm beyond the tip of the needle in the second lumbar intervertebral foramen. The beam spot size was 0.003 cm(2) , irradiance = 35W/cm(2) , exposure time = 84 seconds, energy density = 2800J/cm(2) , total energy was 8.4 J. The low back pain score was assessed by the visual analog scale (VAS) and Pain Relief Scale (PRS) pre, post procedure and in 1 month follow up. Temperature was measured using a digital thermometer. RESULTS All patients in the local anesthetic and laser treatment groups reported a pain reduction of at least 50% immediately post-procedure and 10 out of 11 patients in the radiofrequency group reported a pain reduction of at least 50%. At 1 month post-treatment, the laser treatment group had the greatest number of patients who reported more than 50% pain relief based on PRS (7 out of 10 patients) while only 2 out of 7 patients and 3 out of 11 patients in the lidocaine and radiofrequency treatment groups respectively reported more than a 50% pain relief. CONCLUSION Laser irradiation caused an immediate decrease in low back pain post-procedure similar to pain reduction caused by lidocaine injection. Both lidocaine injection and laser irradiation were more effective than radiofrequency treatment for immediate and longer term (1 month post-treatment) chronic back pain. Lasers Surg. Med. 48:653-659, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Vanessa Milanesi Holanda
- Post Graduate Program in Biophotonics Applied to Health Sciences and in Medicine, University Nove de Julho-UNINOVE, São Paulo, SP, 01504-001, Brazil.,Center of Neurology and Neurosurgery Associates (CENNA), Beneficência Portuguesa of São Paulo Hospital, SP 01323-900 São Paulo, SP 01504-001, Brazil
| | - Maria Cristina Chavantes
- Post Graduate Program in Biophotonics Applied to Health Sciences and in Medicine, University Nove de Julho-UNINOVE, São Paulo, SP, 01504-001, Brazil.,Medical School, São Paulo University, São Paulo, SP, 05402-000, Brazil
| | - Daniela Fatima Teixeira Silva
- Post Graduate Program in Biophotonics Applied to Health Sciences and in Medicine, University Nove de Julho-UNINOVE, São Paulo, SP, 01504-001, Brazil
| | - Carlos Vanderlei M de Holanda
- Center of Neurology and Neurosurgery Associates (CENNA), Beneficência Portuguesa of São Paulo Hospital, SP 01323-900 São Paulo, SP 01504-001, Brazil
| | - José Oswaldo de Oliveira
- Center of Neurology and Neurosurgery Associates (CENNA), Beneficência Portuguesa of São Paulo Hospital, SP 01323-900 São Paulo, SP 01504-001, Brazil.,Medical School, São Paulo University, São Paulo, SP, 05402-000, Brazil.,AC Camargo Cancer Center, São Paulo, SP, 090041-031, Brazil
| | - Xingjia Wu
- Uniformed Services University of the Health Sciences, Bethesda, MD, 20814
| | - Juanita J Anders
- Uniformed Services University of the Health Sciences, Bethesda, MD, 20814
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Soh J, Riemer C, Alkousakis T, Fathi R. Biopsy and Suture Methodology. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thoms S, Cooke M, Crawford J. Cardiovascular Collapse Associated With Irreversible Cardiomyopathy, Chronic Renal Failure, and Hypertension During Routine Dental Care. Anesth Prog 2016; 63:34-41. [DOI: 10.2344/0003-3006-63.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Patients with multiple comorbid conditions visit the dental office every day, and although rare, complications from their conditions may occur during treatment. A case is presented of a 65-year-old African American woman with a history of severe cardiovascular disease, renal disease, and a reported local anesthetic allergy who experienced complete cardiovascular collapse during routine dental treatment from which she was successfully resuscitated. Treating clinicians should recognize the emerging symptoms and be proficient with a basic and advanced cardiac life support protocol to care for their patients safely and effectively until they can be transported to more advanced care facilities.
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Affiliation(s)
- Sean Thoms
- Department of Dental Anesthesiology, University of Pittsburgh, School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Matthew Cooke
- Department of Dental Anesthesiology, University of Pittsburgh, School of Dental Medicine, Pittsburgh, Pennsylvania
| | - James Crawford
- Department of Dental Anesthesiology, University of Pittsburgh, School of Dental Medicine, Pittsburgh, Pennsylvania
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Presman B, Vindigni V, Tocco-Tussardi I. Immediate reaction to lidocaine with periorbital edema during upper blepharoplasty. Int J Surg Case Rep 2016; 20:24-6. [PMID: 26785079 PMCID: PMC4818292 DOI: 10.1016/j.ijscr.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/05/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Blepharoplasty is the fourth most commonly performed cosmetic surgery in the US, with 207,000 operations in 2014. Lidocaine is the preferred anesthetic agent for blepharoplasty. PRESENTATION OF CASE We describe the unusual case of acute periorbital edema following local anesthesia with lidocaine for upper blepharoplasty. At present, only two other reports of periorbital reactions to lidocaine are present in the literature. The reactions observed are significant palpebral swelling and erythema with scaling of the cheek. Fortunately the swelling, although marked, is transient in nature and resolves almost spontaneously without affecting the visual acuity. DISCUSSION Patients reporting adverse reactions should be screened for allergy according to the standard protocols, but skin testing has only been reported to be positive in less than 10% of all cases and allergy confirmation with IgE is even more rare. CONCLUSION In clinical practice, we recommend that patient should be informed about the possibility of recurrence of an adverse reaction in case of re-exposure to lidocaine, even in the vast majority of cases where true allergy could not be proven. In case of further need for local anesthesia with history of an adverse event, a different agent may be chosen even from the same class (another amide) as cross-reactions in the amide group are rare. Otherwise, an anesthetic from the ester group can also be safely used.
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Affiliation(s)
- Benjamin Presman
- Department of Plastic Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Vincenzo Vindigni
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Ilaria Tocco-Tussardi
- Department of Plastic Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden; Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
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29
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Pathogenetische Grundlagen pseudoallergischer Reaktionen. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Syed M, Chopra R, Sachdev V. Allergic Reactions to Dental Materials-A Systematic Review. J Clin Diagn Res 2015; 9:ZE04-9. [PMID: 26557634 PMCID: PMC4625353 DOI: 10.7860/jcdr/2015/15640.6589] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Utility of various dental materials ranging from diagnosis to rehabilitation for the management of oral diseases are not devoid of posing a potential risk of inducing allergic reactions to the patient, technician and dentist. This review aims to develop a systematic approach for the selection and monitoring of dental materials available in the market thereby giving an insight to predict their risk of inducing allergic reactions. MATERIALS AND METHODS Our data included 71 relevant articles which included 60 case reports, 8 prospective studies and 3 retrospective studies. The source of these articles was Pub Med search done with the following terms: allergies to impression materials, sodium hypochlorite, Ledermix paste, zinc oxide eugenol, formaldehyde, Latex gloves, Methyl methacrylate, fissure sealant, composites, mercury, Nickel-chromium, Titanium, polishing paste and local anaesthesia. All the relevant articles and their references were analysed. The clinical manifestations of allergy to different dental materials based on different case reports were reviewed. RESULTS After reviewing the literature, we found that the dental material reported to cause most adverse reactions in patients is amalgam and the incidence of oral lichenoid reactions adjacent to amalgam restorations occur more often than other dental materials. CONCLUSION The most common allergic reactions in dental staff are allergies to latex, acrylates and formaldehyde. While polymethylmethacrylates and latex trigger delayed hypersensitivity reactions, sodium metabisulphite and nickel cause immediate reactions. Over the last few years, due to the rise in number of patients with allergies from different materials, the practicing dentists should have knowledge about documented allergies to known materials and thus avoid such allergic manifestations in the dental clinic.
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Affiliation(s)
- Meena Syed
- Post Graduate Student, Department of Pedodontics, ITS-CDSR Centre for Dental studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Radhika Chopra
- Associate Professor, Department of Pedodontics and Preventive Dentistry, ITS-CDSR Centre for Dental studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Vinod Sachdev
- Professor, HOD and Principal, Department of Pedodontics and Preventive Dentistry, ITS-CDSR Centre for Dental studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
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Senes AM, Calvo AM, Colombini-Ishikiriama BL, Gonçalves PZ, Dionísio TJ, Sant'ana E, Brozoski DT, Lauris JRP, Faria FAC, Santos CF. Efficacy and Safety of 2% and 4% Articaine for Lower Third Molar Surgery. J Dent Res 2015. [PMID: 26202994 DOI: 10.1177/0022034515596313] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This double-blind crossover randomized clinical trial compared the efficacy of 2 concentrations of articaine, 2% (A2) and 4% (A4), with 1:200,000 epinephrine, for lower third molar removal. During 2 separate appointments with either A2 or A4, both similarly positioned lower third molars in 46 volunteers were extracted. The following were evaluated: onset and duration of anesthetic action on soft tissues, intraoperative bleeding, hemodynamic parameters, postoperative analgesia, and mouth opening and wound healing during the 7th postoperative day, along with the incidence, type, and severity of adverse reactions. Nearly identical volumes of both anesthetic solutions were used for each appointment: 3.4 ± 0.9 mL ≈ 68 mg of articaine (A2) and 3.3 ± 0.8 mL ≈ 132 mg of articaine (A4). Statistical analysis indicated no differences in onset or duration of anesthetic action on soft tissues or duration of postoperative analgesia evoked by A2 and A4 anesthetic solutions (P > 0.05). The surgeon's rating of intraoperative bleeding was considered minimal throughout all surgery with both anesthetic solutions. While transient changes in blood pressure, heart rate, and oxygen saturation were observed, these factors were clinically insignificant and were uninfluenced by articaine concentration (P > 0.05). No systemic or local adverse reactions were observed in the preoperative and postoperative periods due to A2 or A4, but 1 case of bilateral paresthesia was observed. There were no significant differences between preoperative and postoperative (7th day) values of mouth opening and wound healing whether volunteers received A2 or A4 (P > 0.05). In conclusion, both A2 and A4, administered in equal volumes, were effective and safe during lower third molar surgery, and no significant differences were found between their efficacy and safety (ClinicalTrials.gov NCT02457325).
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Affiliation(s)
- A M Senes
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - A M Calvo
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - P Z Gonçalves
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - T J Dionísio
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - E Sant'ana
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - D T Brozoski
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - J R P Lauris
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - F A C Faria
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - C F Santos
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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Allergic reaction in the use of primacaine adrenaline. Postepy Dermatol Alergol 2015; 32:134-6. [PMID: 26015784 PMCID: PMC4436236 DOI: 10.5114/pdia.2015.48035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/18/2014] [Accepted: 07/08/2014] [Indexed: 11/17/2022] Open
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34
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Local and General Anesthetics Immediate Hypersensitivity Reactions. Immunol Allergy Clin North Am 2014; 34:525-46, viii. [DOI: 10.1016/j.iac.2014.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Saito M, Abe M, Furukawa T, Yagi M, Koike Y, Wakasugi Y, Tabuchi N, Uno K. Study on patients who underwent suspected diagnosis of allergy to amide-type local anesthetic agents by the leukocyte migration test. Allergol Int 2014; 63:267-77. [PMID: 24759556 DOI: 10.2332/allergolint.13-oa-0653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/05/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are problems in diagnosis of allergy to amide-type local anesthetic agents (ALAs), because definitive diagnosis is not obtained by in vivo tests, which are used for the diagnosis. Consequently, patients may be exposed to risk. There are few diagnoses based on in vitro tests, and there are almost no relevant studies. METHODS Authors examined involvement of allergic reaction using the leukocyte migration test (LMT) through multiple standpoints in 43 patients who underwent suspected diagnosis of allergy to ALAs. RESULTS Rate of LMT-positives was 54%, and especially the positive rate of lidocaine hydrochloride preparations was significantly high. In 15 positives to lidocaine hydrochloride preparations, all cases were indicated as positive in a test with drugs containing antiseptic agent, but only 3 cases were indicated as positive in a test with lidocaine hydrochloride alone. In addition, test with paraben was conducted in 4 cases; 2 cases were confirmed as positive. In relevance of histories of drug or food allergies, development rates of ALAs-allergies were the highest in both allergies, and were 35% and 13%, respectively. CONCLUSIONS There is a high possibility that these adverse reactions were caused by pseudoallergy to drug. Even by allergic reactions, it was assumed that 80% of them might be caused by antiseptic agents such as paraben. In addition, it was suggested that ALAs, especially lidocaine hydrochloride preparations have high antigenicity (sensitizing property). Furthermore, it was considered that patients with past history of drug or food allergies have a high potential for manifestation of the reactions.
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Affiliation(s)
- Mikio Saito
- Laboratory of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Life Sciences, Niigata, Japan
| | - Manabu Abe
- Laboratory of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Life Sciences, Niigata, Japan
| | - Tomoyasu Furukawa
- Department of Pharmacy, Niitsu Medical Center Hospital, Niigata, Japan
| | - Motohiro Yagi
- Department of Pharmacy, Brain Disease Center Agano Hospital, Niigata, Japan
| | | | - Yutaka Wakasugi
- Department of Internal Medicine, Suibarago Hospital, Niigata, Japan
| | - Norihiko Tabuchi
- Laboratory of Molecular Microbiology, Faculty of Pharmacy and Pharmaceutical Sciences, Fukuyama University, Hiroshima, Japan
| | - Katsuji Uno
- Laboratory of Molecular Microbiology, Faculty of Pharmacy and Pharmaceutical Sciences, Fukuyama University, Hiroshima, Japan
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36
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Maher NG, de Looze J, Hoffman GR. Anaphylaxis: an update for dental practitioners. Aust Dent J 2014; 59:142-8; quiz 273. [DOI: 10.1111/adj.12161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- NG Maher
- John Hunter Hospital; Newcastle New South Wales
| | - J de Looze
- John Hunter Hospital; Newcastle New South Wales
| | - GR Hoffman
- John Hunter Hospital; Newcastle New South Wales
- The University of Newcastle; Newcastle New South Wales
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37
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Abstract
Adverse reactions to medications prescribed or administered in dental practice can be worrying. Most of these reactions are somewhat predictable based on the pharmacodynamic properties of the drug. Others, such as allergic and pseudoallergic reactions, are generally unpredictable and unrelated to normal drug action. This article will review immune and nonimmune-mediated mechanisms that account for allergic and related reactions to the particular drug classes commonly used in dentistry. The appropriate management of these reactions will also be addressed.
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Affiliation(s)
- Daniel E Becker
- Associate Director of Education, General Dental Practice Residency, Miami Valley Hospital, Dayton, Ohio
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39
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Park GM, Han HW, Kim JY, Hwang KH, Lee E, Yang SI, Jung YH, Hong SJ, Seo JH, Yu J. Delayed urticaria caused by lidocaine in a child. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.4.298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Geun-Mi Park
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hae Won Han
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yeon Kim
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Keum Hee Hwang
- Special Exam Service, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song-I Yang
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Ho Jung
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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40
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Specjalski K, Kita-Milczarska K, Jassem E. The negative predictive value of typing safe local anesthetics. Int Arch Allergy Immunol 2013; 162:86-8. [PMID: 23816890 DOI: 10.1159/000350763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although allergy to local anesthetics (LA) is rare, patients often report unwanted reactions after their administration. A history of anaphylaxis or an atypical reaction related to LA is an indication for typing a safe anesthetic for future surgical or dental procedures. AIM The aim of the study was to determine the negative predictive value (NPV) of typing safe LA. METHODS A total of 154 patients with a history of an unwanted reaction to LA were enrolled into the study. Stepwise typing of a safe anesthetic included skin prick tests (SPT) and intracutaneous tests (ICT) with two or three of the following LA: lidocaine, bupivacaine, mepivacaine, and articaine. Skin tests were followed by provocations with one or two LA. Telephone follow-up visits were performed 4-12 months after drug typing. On the basis of follow-up questionnaire results, the NPV of the protocol was calculated. RESULTS The full protocol was performed in 148 patients. Positive results of SPT were observed in 2, of ICT in 19 and of provocations in 11 cases. Lidocaine was found safe in 44, bupivacaine in 14, mepivacaine in 34 and articaine in 61 patients. The drug typed at the clinical visit was administered in 78 patients, and 76 reported no reactions (NPV = 97%). CONCLUSION Stepwise approach including SPT, ICT and provocations is safe and allows typing a safe anesthetic in a vast majority of patients.
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41
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Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I. Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2013; 68:702-12. [PMID: 23617635 DOI: 10.1111/all.12142] [Citation(s) in RCA: 541] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 12/15/2022]
Abstract
Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.
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Affiliation(s)
- K. Brockow
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - L. H. Garvey
- Allergy Clinic; Copenhagen University Hospital; Gentofte; Denmark
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz; Austria
| | | | - A. Barbaud
- Dermatology Department and EA 72-98 INGRES; Brabois Hospital; University Hospital of Nancy; Lorraine University; Vandoeuvre les Nancy; France
| | - M. B. Bilo
- Department of Immunology, Allergy and Respiratory Diseases; Allergy Unit; University Hospital Ospedali Riuniti; Ancona; Italy
| | - A. Bircher
- Dermatologische Universitätsklinik Kantonsspital; Basel; Switzerland
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - B. Bonadonna
- Allergy Unit; Verona University Hospital; Verona; Italy
| | - P. Campi
- Allergy and Clinical Immunology Unit; San Giovanni di Dio Hospital; Florence; Italy
| | - E. Castro
- Department of Allergy and Clinical Immunology; Medical University; H. S. Joao; Porto; Portugal
| | - J. R. Cernadas
- Department of Allergy and Clinical Immunology; Medical University; H. S. Joao; Porto; Portugal
| | - A. M. Chiriac
- Allergy Department; University Hospital of Montpellier and INSERM U657; Montpellier; France
| | - P. Demoly
- Allergy Department; University Hospital of Montpellier and INSERM U657; Montpellier; France
| | - M. Grosber
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - J. Gooi
- Department of Immunology; Beaumont Hospital; Dublin; Ireland
| | - C. Lombardo
- Allergy Unit; Verona University Hospital; Verona; Italy
| | - P. M. Mertes
- Service d'anesthésie-réanimation chirurgicale; Hôpitaux Universitaires de Strasbourg; Strasbourg; France
| | - H. Mosbech
- Allergy Clinic; Copenhagen University Hospital; Gentofte; Denmark
| | - S. Nasser
- Department of Allergy; Addenbrooke's Hospital; Cambridge; UK
| | - M. Pagani
- Allergology and Oncology Service; Civil Hospital of Asola; Mantova; Italy
| | - J. Ring
- Department of Dermatology und Allergology Biederstein; Division Environmental Dermatology and Allergology Helmholtz Zentrum München/TUM; Technical University Munich; Munich; Germany
| | - A. Romano
- Allergy Unit; C. I. Columbus; Rome and IRCCS Oasi Maria S. S.; Troina; Italy
| | - K. Scherer
- Dermatologische Universitätsklinik Kantonsspital; Basel; Switzerland
| | - B. Schnyder
- Department of Rheumatology; Clinical Immunology and Allergology; Bern; Switzerland
| | - S. Testi
- Allergy and Clinical Immunology Unit; San Giovanni di Dio Hospital; Florence; Italy
| | - M. Torres
- Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - A. Trautmann
- Department of Dermatology and Allergology; University of Würzburg; Würzburg; Germany
| | - I. Terreehorst
- Department of ENT and Pediatrics; AMC; Amsterdam; The Netherlands
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Sharma V, Harper N, Garcez T, Arkwright P. Allergic reaction to mepivacaine in a child. Br J Anaesth 2013; 110:1059-60. [DOI: 10.1093/bja/aet147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The Rare Case of a Probably True IgE-Mediated Allergy to Local Anaesthetics. Case Rep Med 2013; 2013:201586. [PMID: 23818903 PMCID: PMC3683437 DOI: 10.1155/2013/201586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/20/2013] [Indexed: 11/17/2022] Open
Abstract
The majority of immediate type adverse reactions to local anaesthetics seem to be non-IgE-mediated. We report a case of a 31-year-old woman, who developed conjunctivitis and conjunctival erythema immediately after intrauterine application of a local anaesthetic. Skin prick testing and intradermal testing were done with lidocaine, mepivacaine, and procaine. Intradermal testing showed positive reactions to mepivacaine (1 : 10), undiluted lidocaine, and procaine (1 : 10 and undiluted). Specific IgE could be detected against mepivacaine, but not against latex. Serum tryptase was in the normal range. In order to rule out the exceptional case of a true IgE-mediated reaction, allergy testing with local anaesthetics is still required in the workup of patients.
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Batinac T, Sotošek Tokmadžić V, Peharda V, Brajac I. Adverse reactions and alleged allergy to local anesthetics: Analysis of 331 patients. J Dermatol 2013; 40:522-7. [DOI: 10.1111/1346-8138.12168] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Tanja Batinac
- Department of Dermatovenereology; University Hospital Center Rijeka; Rijeka; Croatia
| | - Vlatka Sotošek Tokmadžić
- Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine; University of Rijeka; Rijeka; Croatia
| | - Vesna Peharda
- Department of Dermatovenereology; University Hospital Center Rijeka; Rijeka; Croatia
| | - Ines Brajac
- Department of Dermatovenereology; University Hospital Center Rijeka; Rijeka; Croatia
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Rosenberg MB, Phero JC, Giovannitti JA. Management of allergy and anaphylaxis during oral surgery. Oral Maxillofac Surg Clin North Am 2013; 25:401-6, vi. [PMID: 23680577 DOI: 10.1016/j.coms.2013.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Minor and major allergic reactions occur during oral and maxillofacial treatment. Immediate diagnosis and pharmacologic intervention are imperative. Signs and symptoms may be variable. The early administration of epinephrine is critical.
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Affiliation(s)
- Morton B Rosenberg
- Division of Anesthesia and Pain Control, Tufts University School of Dental Medicine, Tufts University School of Medicine, 1 Kneeland Street Boston, MA 02111, USA.
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46
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Aksu K, Kurt E. Immediate reaction to articaine. Allergol Immunopathol (Madr) 2013; 41:127-8. [PMID: 22682990 DOI: 10.1016/j.aller.2012.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 02/03/2012] [Accepted: 02/04/2012] [Indexed: 10/28/2022]
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47
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Yeo JY, Kim GE, Han JY, Im JH, Park SW, Kim CW. Lidocaine anaphylaxis and lidocaine-specific immunoglobulin E measurement. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.1.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jin Yeop Yeo
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Gyung Eun Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ju Young Han
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sung Wook Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Cheol-Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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Kao L, Rajan J, Roy L, Kavosh E, Khan DA. Adverse reactions during drug challenges: a single US institution's experience. Ann Allergy Asthma Immunol 2012; 110:86-91.e1. [PMID: 23352526 DOI: 10.1016/j.anai.2012.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/02/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Drug challenge is a useful tool when diagnostic testing lacks predictive value for a questionable history of drug allergy. Placebo-controlled drug challenge studies demonstrate that a significant number of patients report purely subjective symptoms to placebo. OBJECTIVE To evaluate the safety and rate of adverse effects when performing drug challenges and to identify predictive factors for occurrences of subjective symptoms during drug challenges. METHODS We performed a 6-year, retrospective medical record review of patients who underwent drug challenges by members of the Allergy and Immunology Division after consultation deemed drug challenges to be appropriate. Statistical analysis was performed to compare the proportion of patients with subjective symptoms based on certain factors, including sex, age, number of listed drug allergies, interval from historical drug reaction to the drug challenge, and types of historical reaction. RESULTS A total of 114 patients underwent 123 drug challenges. Only 1 patient was deemed to have a true positive drug challenge result. Twenty patients reported subjective symptoms during graded challenge, all of which were not deemed a positive challenge. There was a significantly higher proportion of patients who reported subjective symptoms in females, those with a higher number of listed drug allergies, and those whose historical reactions were primarily subjective in nature. CONCLUSION Drug challenges are safe procedures in appropriately selected patients. A number of patients report subjective symptoms during drug challenges. Identifying patients at high risk for subjective symptoms may assist in determining whether placebo-controlled drug challenges should be performed.
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Affiliation(s)
- Leon Kao
- Division of Allergy and Immunology at the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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49
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Calderon AL, Diot N, Benatir F, Christin F, Hautin E, Truc C, Allaouchiche B, Boselli E. Immediate allergic cross-reactivity to levobupivacaine and ropivacaine. Anaesthesia 2012; 68:203-5. [PMID: 23121555 DOI: 10.1111/j.1365-2044.2012.07314.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Allergic reactions to amide local anaesthetic agents are rare. We report the case of a 74-year-old man who suffered anaphylaxis, presenting with cardiovascular collapse, immediately after receiving regional anaesthesia on two separate occasions, the first involving the use of levobupivacaine and the second using ropivacaine. Skin testing revealed positive reactions to both levobupivacaine and ropivacaine, and negative reactions to articaine and lidocaine. Severe allergic reactions can be caused by the amide local anaesthetic drugs, levobupivacaine and ropivacaine.
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Affiliation(s)
- A L Calderon
- Department of Anaesthesiology and Intensive Care, Édouard Herriot Hospital, HCL, Lyon, France
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50
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Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog 2012; 59:90-101; quiz 102-3. [PMID: 22822998 DOI: 10.2344/0003-3006-59.2.90] [Citation(s) in RCA: 321] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. Their use is so routine, and adverse effects are so infrequent, that providers may understandably overlook many of their pharmacotherapeutic principles. The purpose of this continuing education article is to provide a review and update of essential pharmacology for the various local anesthetic formulations in current use. Technical considerations will be addressed in a subsequent article.
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Affiliation(s)
- Daniel E Becker
- General Dental Practice Residency, Miami Valley Hospital, Dayton, Ohio, 45409,
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