The incremental challenge test in the diagnosis of adverse reactions to local anesthetics.
OBJECTIVE
The aim of this study was to assess the reliability of a diagnostic protocol, the incremental challenge test (ICT), for patients with and without a history of adverse reactions to local anesthetics (LAs) or other drugs, to select an LA that could be safely used.


METHODS
The ICT was performed on 432 subjects, 314 female and 118 male. Four hundred thirty-two challenges were carried out with LAs that were free of adrenaline and preservatives. Chi-square analysis was performed to evaluate the existence of different predispositions to ICT positivity among subjects of the 4 categories studied.


RESULTS
Four hundred fifteen tests were completed with no clinical events occurring. The analysis did not show any significant difference (chi-square = 6.17; P >.05).


CONCLUSIONS
Our results confirm that immunoglobulin E-mediated reactions to LAs are uncommon and that the ICT offers safety and specificity in diagnosing adverse reactions to LAs, allowing for the selection of a safe and reliable LA.
Nettis
E
E
Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Italy. e.nettis@allergy.uniba.it
Napoli
G
G
Ferrannini
A
A
Tursi
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000175:diagnosis*; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012882:Skin Tests / Q000379:methods*
D000779:Anesthetics, Local; D007073:Immunoglobulin E