[Main principles of pathogenesis, diagnostics and prevention of drug allergy caused by local anaesthetics].
Often reasons of drug allergy are local anaesthetics. True allergic reactions are presented by the contact allergic dermatitis (the 4th type of allergic reaction, mediated by sensitized G-lymphocyte), while the reactions of instant type such as anaphylactic one can be observed rarely. So, if the drug allergy is clinically presented by contact allergic dermatitis, Novocain can be replaced by Lydocaine as they don't have similar chemical structure (the same antigenic features). However, in case of the anaphylactic (pseudo allergic) reactions, the main focus become the general mechanisms of local anaesthetic effects (instant toxic effect which are the same as Novocain, Lydocaine and all other local anaesthetics. This is why in case of anaphylactic reaction the substitution of Novocain by Lydocaine is not recommended. When conducting a skin test, if the drug which had caused an allergic reaction has not been identified, it is better to use the drug of the 2nd group. During the last 14 years the allergy department in the Central Clinic of TSMU, after negative skin tests (prick-test) on local anesthetics we conduct provocation tests on local anaesthetics which contain vasoconstrictive substance adrenaline (Ultracaine, Ubistezine, etc ). In 2008 this test was conducted with 1125 patients. Only in two cases the allergic reactions were observed in the form of edema and hyperemia of mucous membrane, headache and dizziness. In case of use of these drugs the system allergic reactions were not observed. So, the sublingual provocation test is a safe and reliable diagnostic test which prevents heavy system reactions, which correlates with data given by V. Pytski. Although measurable test, pre-medication, desensitization in most cases gives us the opportunity to prescribe the proper medicine, we should not forget about potential danger of reaction appearance and be ready to relief the symptoms rapidly. In addition, we should not forget about juridical, forensic aspects and, in particular, medical card must include informational agreement, precisely documented necessity of medical procedure, and respective consultations of specialists.
B V
BV
Machavariani
Ts G
TsG
Sakandelidze
Z Dzh
ZD
Chuchua
I U
IU
Saparishvili
D000779:Anesthetics, Local / Q000009:adverse effects*; D003937:Diagnosis, Differential; D018450:Disease Progression; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans
D000779:Anesthetics, Local