Khalil Sally, Taha Salma, Al-Nesf Maryam
Allergy Immunology division, Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail:
Qatar Med J. 2022 Mar 28;2022(2):16. doi: 10.5339/qmj.2022.fqac.16. eCollection 2022.
Adverse reactions to local anesthetics (LA) are relatively common; however, true IgE-mediated allergy is extremely rare, estimated to occur in less than 1%. Investigating patients with suspected allergy to LA should begin with a detailed history to exclude other more common operation theater related culprit medications, followed by skin testing. The subcutaneous challenge is considered the gold standard for confirming true IgE-mediated allergy to LA. In this study, we have described the skin prick test results of patients with suspected lidocaine allergy who had historical reaction symptoms typical to IgE-mediated allergic reactions.
The data were retrieved from the allergy procedure log registry for patients who were referred to the allergy clinic with a suspected allergic reaction to lidocaine at the Hamad Medical Corporation between 2016 and 2020. These patients' symptoms of historical reactions to lidocaine were compared to their skin test results.
A total of 7 patients were identified. The skin test result for lidocaine was positive in only 1 patient; his historical reaction was anaphylaxis (urticaria/angioedema and shortness of breath). The remaining 6 patients had a negative result for skin and challenge tests. Of these 6 patients with negative results, 4 had only urticaria/angioedema as historical reactions; 1 had systematic manifestation (tachycardia) along with urticaria/angioedema, and 1 experienced systemic symptoms (shortness of breath, chest pain, and palpitation) with no skin or mucous membrane involvement (Table 1).
Negative skin test and subcutaneous challenge with a history of generalized cutaneous symptoms and/or systemic symptoms during the reaction to LA can be attributed to many causes, such as an IgE-mediated reaction against a component other than lidocaine (e.g., latex), medication side effects (adrenaline in combined preparations), and/or symptoms of primary disease (chronic spontaneous urticaria/angioedema).
局部麻醉药（LA）的不良反应相对常见；然而，真正由免疫球蛋白E（IgE）介导的过敏极为罕见，估计发生率低于1%。对疑似LA过敏的患者进行调查时，应首先详细询问病史，以排除其他更常见的与手术室相关的可疑药物，然后进行皮肤试验。皮下激发试验被认为是确诊真正由IgE介导的LA过敏的金标准。在本研究中，我们描述了疑似利多卡因过敏且有IgE介导的过敏反应典型既往症状的患者的皮肤点刺试验结果。
数据取自2016年至2020年期间因疑似对利多卡因过敏而转诊至哈马德医疗公司过敏诊所的患者的过敏检查记录登记册。将这些患者利多卡因既往反应的症状与其皮肤试验结果进行比较。
共识别出7例患者。仅1例患者利多卡因皮肤试验结果呈阳性；其既往反应为过敏反应（荨麻疹/血管性水肿和呼吸急促）。其余6例患者皮肤试验和激发试验结果均为阴性。在这6例结果为阴性的患者中，4例既往反应仅为荨麻疹/血管性水肿；1例除荨麻疹/血管性水肿外还有全身表现（心动过速），1例出现全身症状（呼吸急促、胸痛和心悸）但无皮肤或黏膜受累（表1）。
LA反应期间出现全身性皮肤症状和/或全身症状且皮肤试验和皮下激发试验结果为阴性，可能有多种原因，如针对利多卡因以外成分（如乳胶）的IgE介导反应、药物副作用（复方制剂中的肾上腺素）和/或原发性疾病症状（慢性自发性荨麻疹/血管性水肿）。
