Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, UFR Odontologie, CHU de Nantes, Unité Fonctionnelle de Chirurgie Orale, PHU4 OTONN, ONIRIS, Nantes, France.
Service de Pharmacologie Clinique, CHU de Nantes, Nantes, France.
Clin Oral Investig. 2022 Feb;26(2):1667-1676. doi: 10.1007/s00784-021-04139-5. Epub 2021 Aug 24.
The primary aims of the present study were (1) to quantify and characterize anaphylactic type I reactions related to local anesthetics (LAs) drawing on the French Pharmacovigilance Database System over a 35-year period and (2) to focuse on reactions associated with dental procedures. The secondary aim was to infer an incidence rate in dental practice.
All cases of anaphylactic reactions were selected using the algorithmic Standardized MeDRA Query "anaphylactic reaction." For each reaction, comprehensive data were collected, in particular the severity of symptoms, risk factors for anaphylaxis, and allergy testing. Imputability was assessed and a crude incidence rate in dental practice was estimated.
The first-line search identified 416 anaphylactic reactions, mostly of grade II (138) or III (240) severity. When restricted to dental practice, this number fell to 26 (grade I: 4; grade II: 10; grade III: 11; and grade IV: 1). Lidocaine was most often involved (81.49%) and mostly associated with anaphylactic reactions of grade II and III. Overall, 11 cases of fatal anaphylaxis were recorded, but no in dental practice. In dental practice, lidocaine was also the most frequently involved LA (57.69%).
All these findings highlight the very low incidence of type I-IgE-mediated reactions to LA, particularly in dental practice. The incidence rate of LA anaphylctic episodes in dental practice was estimated as 0.0261 anaphylactic episodes per million LA cartridges.
True anaphylactic reactions to LAs do occur and may justify a thorough investigation in dental practice.
本研究的主要目的是（1）利用法国药物警戒数据库系统在 35 年期间量化和描述与局部麻醉剂（LA）相关的 I 型过敏反应的特征，以及（2）重点关注与牙科手术相关的反应。次要目的是推断牙科实践中的发病率。
使用算法标准 MedDRA 查询“过敏反应”选择所有过敏反应病例。对于每个反应，都收集了全面的数据，特别是症状的严重程度、过敏反应的危险因素和过敏测试。评估了可归因性，并估计了牙科实践中的发病率。
一线搜索确定了 416 例过敏反应，主要为 II 级（138）或 III 级（240）严重程度。当限制在牙科实践中时，这一数字降至 26 例（I 级：4；II 级：10；III 级：11；和 IV 级：1）。利多卡因最常涉及（81.49%），主要与 II 级和 III 级过敏反应相关。总体而言，记录了 11 例致命性过敏反应病例，但在牙科实践中没有。在牙科实践中，利多卡因也是最常涉及的 LA（57.69%）。
所有这些发现都强调了 I 型-IgE 介导的对 LA 的过敏反应发生率非常低，特别是在牙科实践中。牙科实践中 LA 过敏反应的发生率估计为每百万 LA 管 0.0261 次过敏反应。
LA 确实会发生真正的过敏反应，并且可能需要在牙科实践中进行彻底调查。
