title: Long-term absence of sensitization to mepivacaine as assessed by a diagnostic protocol including patch testing.
abstract: BACKGROUND
  Prospective assessment of non-reactivity to local anaesthetics is a frequent reason for allergy consultation.
  
  
  OBJECTIVE
  To investigate the clinical profiles of subjects referred for allergy evaluation; to prospectively reduce the frequency of evaluation by assessing the persistence, during clinical use, of non-reactivity to contaminant/additive-free mepivacaine; and to determine the usefulness of a diagnostic protocol involving patch testing.
  
  
  METHODS
  In a prospective study, 198 consecutive patients underwent collection of clinical data, skin prick tests and patch tests using allergens/antigens relevant for the investigation, and an intradermal/subcutaneous challenge procedure using contaminant/additive-free mepivacaine, as appropriate. Patients were followed up for 3 years for assessment of non-reactivity persistence using the same diagnostic protocol.
  
  
  RESULTS
  Only one-third of the patients had a history of previous adverse local anaesthetic reactions. Absence of sensitization to contaminant/additive-free mepivacaine persisted in all subjects completing the follow-up. Controlled challenge with mepivacaine was negative in 196 patients with both negative specific skin prick tests and patch tests but it was eventful in two subjects with positive specific patch tests. A few subjects displayed positive skin prick tests and/or patch tests for latex and/or additives.
  
  
  CONCLUSIONS
  A few patients had a relevant history for potential local anaesthetic-induced adverse reactions. Upon assessment of absence of sensitization and reactivity, contaminant/additive-free mepivacaine could safely be given for as long as 3 years. The patch testing was shown to be useful and safe for prediction of challenge outcomes. True allergic reactions to contaminant/additive-free mepivacaine were not observed in our patient series.
authors.affiliation: Section of Allergology and Clinical Immunology, Division of Internal Medicine, F. Magrassi Department of Clinical and Experimental Medicine, Second University of Naples School of Medicine, Naples, Italy. astcor@sorrento.argosid.it
authors.forename: C
authors.initials: C
authors.lastname: Astarita
authors.forename: D
authors.initials: D
authors.lastname: Gargano
authors.forename: C
authors.initials: C
authors.lastname: Romano
authors.forename: M
authors.initials: M
authors.lastname: Cutajar
authors.forename: F
authors.initials: F
authors.lastname: Manguso
authors.forename: D
authors.initials: D
authors.lastname: Montanaro
authors.forename: A
authors.initials: A
authors.lastname: Napolitano
authors.forename: F
authors.initials: F
authors.lastname: Pezzuto
authors.forename: M
authors.initials: M
authors.lastname: Lo Schiavo
authors.forename: P
authors.initials: P
authors.lastname: Altucci
authors.forename: G
authors.initials: G
authors.lastname: Abbate
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects*; D002648:Child; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000175:diagnosis; D007114:Immunization / Q000009:adverse effects*; D008297:Male; D008619:Mepivacaine / Q000009:adverse effects*; D008875:Middle Aged; D010328:Patch Tests / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013995:Time
chemical_list: D000318:Adrenergic beta-Agonists; D000779:Anesthetics, Local; D008619:Mepivacaine; D004837:Epinephrine