Delayed-type hypersensitivity to lidocaine.
BACKGROUND
Lidocaine hydrochloride is the preferred anesthetic agent used in outpatient surgical procedures. While type I hypersensitivity reactions to lidocaine are uncommon, type IV hypersensitivity is reported even less frequently.


METHODS
Between January 1, 2001, and December 31, 2001, 183 patients were patch tested at the Penn State Milton S. Hershey Medical Center (Hershey, Pa) to the North American Contact Dermatitis Group tray. All patients who had a positive patch test reaction to lidocaine were challenged with 0.1 mL of preservative-free 1% lidocaine intradermally. Of the 183 patients patch tested, 4 had positive reactions to lidocaine, 2 of whom had histories of sensitivity to local injections of lidocaine manifested by dermatitis.


CONCLUSIONS
Delayed-type hypersensitivity to lidocaine may occur more frequently than previously thought. In cases of suspected lidocaine contact type IV sensitivity, patients should be patch tested to lidocaine. Positive patch test reactions should be confirmed by intradermal challenge with lidocaine. To provide the patient with alternative local anesthetics, patch testing should be performed with other injectable anesthetics. If positive patch test results occur, intradermal testing should follow.
Mackley
Christine L
CL
Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. cmackley@psu.edu
Marks
James G
JG
Anderson
Bryan E
BE
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000453:epidemiology* / Q000473:pathology; D007428:Intradermal Tests; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D010328:Patch Tests; D010414:Pennsylvania / Q000453:epidemiology
D000779:Anesthetics, Local; D008012:Lidocaine