title: Evaluating a dental patient for local anesthesia allergy.
abstract: The determination of particular allergens with respect to local anesthetics may present difficulty within the realm of clinical dentistry. A case is presented that dramatizes the difficulties in determining the specific allergen after a patient undergoing several episodes of restorative dentistry with several varying regimens of local anesthesia repeatedly reacted with skin rashes and pruritus approximately 36 hours after treatment. The patient was a 76-year-old man with a complex medical history. A challenge procedure performed with a commercial formulation of local anesthesia resulted in a positive delayed hypersensitivity reaction. An additional challenge procedure with cardiac lidocaine resulted in a negative challenge. A latex-induced delayed-type hypersensitivity reaction was suspected but unproven because the patient declined further allergy testing. Therefore, the conclusion was that the allergen was an unknown substance within the commercial local anesthetic formulation.
authors.affiliation: Department of Oral and Maxillofacial Pathology, Department of Oral Diagnosis and Radiology, Howard University College of Dentistry, Washington, DC, USA.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Brown
authors.forename: Srinagesh
authors.initials: S
authors.lastname: Paluvoi
authors.forename: Soli
authors.initials: S
authors.lastname: Choksi
authors.forename: Cheryl M
authors.initials: CM
authors.lastname: Burgess
authors.forename: Elena R
authors.initials: ER
authors.lastname: Reece
mesh_terms: D000368:Aged; D000485:Allergens / Q000145:classification; D000766:Anesthesia, Dental; D000779:Anesthetics, Local / Q000009:adverse effects* / Q000145:classification; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D005076:Exanthema / Q000139:chemically induced; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis / Q000209:etiology; D020315:Latex Hypersensitivity / Q000175:diagnosis; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008619:Mepivacaine / Q000009:adverse effects; D010328:Patch Tests; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects; D011537:Pruritus / Q000139:chemically induced
chemical_list: D000485:Allergens; D000779:Anesthetics, Local; D011310:Preservatives, Pharmaceutical; D008012:Lidocaine; D008619:Mepivacaine