Allergy Unit, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain.
Allergy Unit, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain.
J Allergy Clin Immunol Pract. 2018 Jan-Feb;6(1):201-207. doi: 10.1016/j.jaip.2017.06.013. Epub 2017 Aug 30.
Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine.
To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation.
We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard.
After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy.
Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.
局部麻醉剂（LA），尤其是酯类，的不良反应并不罕见，但真正的过敏反应却很少被诊断出来。据我们所知，目前还没有可靠的方法来确定对 LA 和可卡因的 IgE 介导的过敏反应。
评估过敏测试（划痕、IgE、挑战和数组）在因可卡因衍生物局部麻醉而出现过敏反应（哮喘和过敏反应）和因吸入可卡因而出现过敏症状的可卡因成瘾者中的临床价值。
我们从 23873 名患者的数据库中选择了因局部麻醉而出现严重反应的可卡因依赖患者和过敏患者。使用可卡因和古柯叶提取物进行过敏测试的诊断收益（敏感性、特异性和预测值），以阳性挑战作为标准。
在划痕试验、特异性 IgE 和可卡因提取物挑战后，211 名患者中有 41 名（19.4%）被诊断为对可卡因过敏。划痕试验和对古柯叶（古柯茶）的 IgE 对可卡因过敏和 LA 衍生过敏的诊断具有很好的敏感性（分别为 95.1%和 92.7%）和特异性（分别为 92.3%和 98.8%）。
可卡因可能是一种重要的过敏原。可卡因成瘾者和对局部麻醉和烟草敏感的患者有风险。划痕试验和特异性 IgE 均可检测到对古柯叶提取物的过敏反应。最高水平与严重的临床特征有关。
