Delayed urticaria caused by lidocaine in a child

Geun-Mi Park; Hae Won Han; Jae Yeon Kim; Keum Hee Hwang; Eun Lee; Song-I Yang; Young-Ho Jung; Soo-Jong Hong; Ju-Hee Seo; Jinho Yu

doi:10.4168/aard.2014.2.4.298

Journal List > Allergy Asthma Respir Dis > v.2(4) > 1059043

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Han, Kim, Hwang, Lee, Yang, Jung, Hong, Seo, and Yu: Delayed urticaria caused by lidocaine in a child

Case Report

Allergy Asthma Respir Dis 2014;2(4):298-301.

Published online: 12 September 2014

DOI: https://doi.org/10.4168/aard.2014.2.4.298

Delayed urticaria caused by lidocaine in a child

Geun-Mi Park¹, Hae Won Han¹, Jae Yeon Kim¹, Keum Hee Hwang², Eun Lee³, Song-I Yang³, Young-Ho Jung³, Soo-Jong Hong³, Ju-Hee Seo⁴, Jinho Yu³

^¹Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Seoul Korea

^²Department of Special Exam Service, Asan Medical Center, University of Ulsan College of Medicine, Seoul Korea

^³Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul Korea

^⁴Department of Pediatrics, Korea Cancer Center Hospital, Seoul Korea

Correspondence to: Jinho Yu Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3922, Fax: +82-2-473-3725, E-mail: jyu3922@gmail.com

Received 12 December 2013 Revised 25 February 2014 Accepted 10 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lidocaine is a commonly used local anesthetic for dental treatment. Urticaria caused by lidocaine has seldom been reported. Generally, urticaria immediately develops after exposure to a causative agent and is considered a manifestation of IgE-mediated hypersensitivity. However, delayed urticaria caused by local anesthetics was reported to be related to cell mediated hypersenstivity. A 3-year old girl visited our allergy clinic due to delayed urticaria after local administration of lidocaine. Both skin prick and intradermal tests with lidocaine revealed negative reactions. However, the provocation test with subcutaneous injection of lidocaine showed urticaria 7 hours after test. In order to identify alternative local anesthetic for the subsequent dental procedure, we performed skin prick, intradermal and provocation tests with procaine, a local anesthetic of the other class, all of which showed negative results. Therefore, we recommended procaine as an alternative local anesthetic, and the patient was successfully treated with procaine. To the best of our knowledge, this is the first case of delayed urticaria caused by lidocaine in Korea.

Keywords: Lidocaine, Local anesthetic, Urticaria, Adverse drug reaction

References

1. Berkun Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience with 236 patients. Ann Allergy Asthma Immunol. 2003; 91:342–5.

2. Gall H, Kaufmann R, Kalveram CM. Adverse reactions to local anesthetics: analysis of 197 cases. J Allergy Clin Immunol. 1996; 97:933–7.

3. Mertes PM, Laxenaire MC. Allergic reactions occurring during anaesthesia. Eur J Anaesthesiol. 2002; 19:240–62.

4. Schatz M. Skin testing and incremental challenge in the evaluation of adverse reactions to local anesthetics. J Allergy Clin Immunol. 1984; 74(4 Pt 2):606–16.

5. Lee SM, Song WJ, Yang MS, Lee SH, Kwon JW, Kim TW, et al. A case of lidocaine anaphylaxis. Korean J Asthma Allergy Clin Immunol. 2006; 26:249–53.

6. Yeo JY, Kim GE, Han JY, Im JH, Park SW, Kim CW. Lidocaine anaphylaxis and lidocaine-specific immunoglobulin E measurement. Allergy Asthma Respir Dis. 2013; 1:98–101.

7. Thyssen JP, Menne T, Elberling J, Plaschke P, Johansen JD. Hypersensitivity to local anaesthetics: update and proposal of evaluation algorithm. Contact Dermatitis. 2008; 59:69–78.

8. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003; 58:854–63.

9. Naguib M, Magboul MM, Samarkandi AH, Attia M. Adverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf. 1998; 18:221–50.

10. Schwartz HJ, Sher TH. Bisulfite sensitivity manifesting as allergy to local dental anesthesia. J Allergy Clin Immunol. 1985; 75:525–7.

11. Primeau MN, Adkinson NF Jr, Hamilton RG. Natural rubber pharmaceutical vial closures release latex allergens that produce skin reactions. J Allergy Clin Immunol. 2001; 107:958–62.

12. Vu AT, Lockey RF. Benzocaine anaphylaxis. J Allergy Clin Immunol. 2006; 118:534–5.

13. Curley RK, Macfarlane AW, King CM. Contact sensitivity to the amide anesthetics lidocaine, prilocaine, and mepivacaine. Case report and review of the literature. Arch Dermatol. 1986; 122:924–6.

14. Klein CE, Gall H. Type IV allergy to amide-type local anesthetics. Contact Dermatitis. 1991; 25:45–8.

15. Prieto A, Herrero T, Rubio M, Tornero P, Baeza ML, Velloso A, et al. Urticaria due to mepivacaine with tolerance to lidocaine and bupivacaine. Allergy. 2005; 60:261–2.

16. McClimon B, Rank M, Li J. The predictive value of skin testing in the diagnosis of local anesthetic allergy. Allergy Asthma Proc. 2011; 32:95–8.

17. Fuzier R, Lapeyre-Mestre M, Mertes PM, Nicolas JF, Benoit Y, Didier A, et al. Immediate- and delayed-type allergic reactions to amide local anesthetics: clinical features and skin testing. Pharmacoepidemiol Drug Saf. 2009; 18:595–601.

18. Sanico AM, Saini SS. Immediate hypersensitivity: approach to diagnosis. Adelman DC, Casale TB, Corren J, editors. Manual of Allergy and immunology. 4th ed.Philadelphia: Lippincott, Williams & Wilkins;2002. p. 24–43.

19. Pichler WJ, Naisbitt DJ, Park BK. Immune pathomechanism of drug hypersensitivity reactions. J Allergy Clin Immunol. 2011; 127(3 Suppl):S74–81.

20. Orasch CE, Helbling A, Zanni MP, Yawalkar N, Hari Y, Pichler WJ. T-cell reaction to local anaesthetics: relationship to angioedema and urticaria after subcutaneous application–patch testing and LTT in patients with adverse reaction to local anaesthetics. Clin Exp Allergy. 1999; 29:1549–54.

Table 1.

The results of skin prick test and intradermal test for local anesthetics

Variable	Prick test (1:1)		Intradermal test (1:100)
Variable	Wheal (mm)	Erythema	Wheal (mm)	Erythema
Control
Saline	0	–	6 × 6	+
Histamine	3 × 3	+	16 × 11	+
Local anesthetics
Lidocaine 2%	0	–	0	–
Bupivacaine 0.5%	0	–	7 × 6	+
Ropivacaine 0.2%	0	–	8.6 × 6	+
Proparacaine 0.5%	0	–
Procaine 2%	0	–	7 × 6	+

Table 2.

Classes of local anesthetics

Benzoic acid esters	Amides
Benzocaine	Articaine
Butamben picrate	Bupivacaine
Chloroprocaine	Levobupivicaine
Cocaine	Lidocaine
Procaine	Mepicacaine
Proparacaine	Prilocaine
Tetracaine	Ropivacaine

TOOLS

Similar articles