Grzanka Alicja, Misiołek Hanna, Filipowska Agata, Miśkiewicz-Orczyk Katarzyna, Jarząb Jerzy
Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia in Katowice, Zabrze, Poland.
Anestezjol Intens Ter. 2010 Oct-Dec;42(4):175-8.
There are several kinds of adverse reactions to the administration of local anaesthetics (LAs): hypersensitivity, which causes reproducible symptoms or signs, initiated by exposure to a defined stimulus at a dose tolerated by normal subjects; toxic reactions - caused by overdose or inappropriate administration; and allergy - when an immunologic mechanism can be shown to be important.The most serious adverse reaction is anaphylaxis, which can be of allergic or non-allergic (anaphylactoid) origin. We analysed clinical adverse reactions to local anaesthetic agents that occurred in the Silesian region.
Thirty-two patients, aged 22-56 years, in whom significant reactions had occurred after administration of an LA, were investigated in our institution. The investigation was based on skin prick, intradermal injections and patch testing. In every patient, the concentration of latex IgE antibodies was measured.
True allergic reactions were confirmed in three patients. The allergens were: lidocaine in all three cases, additionally: nickel - in one person and preservative (paraben) - in one patient. No latex allergy was diagnosed.
The results showed that real allergic reactions to LA agents are rare and that most of the reported reactions were caused by hypersensitivity. Nevertheless, in each case of adverse reaction, careful review of the history, and testing of immediate and late allergic reactions not only to LA but also to latex and preservatives, should be mandatory.
局部麻醉药（LA）给药存在几种不良反应：超敏反应，由正常受试者耐受剂量的特定刺激引发，会导致可重现的症状或体征；毒性反应——由用药过量或不当给药引起；以及过敏反应——当免疫机制被证明起重要作用时。最严重的不良反应是过敏反应，其可能源于过敏或非过敏（类过敏）。我们分析了西里西亚地区发生的局部麻醉药临床不良反应。
我们机构对32名年龄在22至56岁之间、在使用LA后出现显著反应的患者进行了调查。调查基于皮肤点刺、皮内注射和斑贴试验。对每位患者测量乳胶IgE抗体浓度。
三名患者被确诊为真正的过敏反应。过敏原分别为：三例均为利多卡因，另外：一例为镍，一例为防腐剂（对羟基苯甲酸酯）。未诊断出乳胶过敏。
结果表明，对LA制剂的真正过敏反应很少见，大多数报告的反应是由超敏反应引起的。然而，在每例不良反应中，仔细回顾病史以及检测对LA、乳胶和防腐剂的速发型和迟发型过敏反应都是必要的。
