Intradermal Tests for Diagnosis of Drug Allergy are not Affected by a Topical Anesthetic Patch

Desensitization in children allergic to drugs: Indications, protocols, and limits

Any drug can potentially induce a hypersensitivity reaction. If after the allergological work-up the drug hypersensitivity reaction is confirmed, in most cases, the simple avoidance of the culprit drug and a suggestion of an unrelated alternative is enough. However, there are circumstances where the choice to stop the treatment affects the survival, the safety and/or the quality of life of the patient and the global outcome of the disease in question. When this occurs, drug desensitization can be the answer and should not be viewed as an extravagance, nor the pediatric age should be considered a contraindication. Drug desensitization in children can be safely and successfully performed, having a positive impact on the survival and overall prognosis. In general, the indications for DDS are the same in adults as in children. However, in this age group there are specificities that this paper aimed to describe, reviewing the mechanisms behind drug hypersensitivity and rapid drug desensitization, types of protocols, indications, and contraindications, as well as several technical aspects that are specific to the pediatric age.

The effect of topical lidocaine on intradermal testing in atopic dogs

BACKGROUND

Intradermal testing (IDT) most often requires sedation. Topical lidocaine offers an adjunct or alternative to sedation.

HYPOTHESIS/OBJECTIVES

We hypothesized that topical lidocaine would significantly reduce reactions to intradermal injections and that atopic dogs treated with topical lidocaine would have similar results with IDT to atopic dogs tested without topical lidocaine.

ANIMALS

Fifteen client-owned atopic dogs.

METHODS

In Part I, a 5% lidocaine patch, 5% lidocaine cream and a control with no active ingredients were compared. The lowest pain score during intradermal injection was established in six atopic dogs. Fifteen atopic dogs were enrolled in Part II, and lidocaine cream (found to be most effective in Part 1) was applied randomly to a single side of the thorax. An IDT was performed on each side of the chest. Subjective and objective scores of the control and lidocaine treatment sides were compared 15 and 30 min post-injection.

RESULTS

The 5% lidocaine cream had the greatest reduction in pain score associated with intradermal injection. There were no significant differences in mean wheal diameter for any evaluated allergen at any time point between the control and lidocaine-treated sides. There was high agreement between the two groups when assessing the subjective score for all but one allergen.

CONCLUSIONS AND CLINICAL IMPORTANCE

Topical lidocaine may be used as adjunctive analgesia during IDT with caution in interpretation of subjective house dust scoring. Lidocaine cream appeared to reduce pain score and may allow reduction in concurrent sedation.