Troise C, Voltolini S, Minale P, Modena P, Negrini A C
Allergy Unit, St. Martino Hospital, Genoa, Italy.
J Investig Allergol Clin Immunol. 1998 May-Jun;8(3):172-5.
Local anesthetics are among the most used drugs in clinical practice. Various types of reactions have been reported and many patients are told that they are allergic to caines or are at risk of allergic reactions. We report our experience with 386 patients using skin test and progressive subcutaneous challenge in order to select a local anesthetic that could be safely used. The patients underwent specific protocol including clinical history, prick and intradermal tests, and subcutaneous incremental challenge with a local anesthetic from the amide group which was free of preservatives and vasoconstrictors. Thirteen patients showed a positive skin test: 10 with positive prick test underwent the subsequent challenge with no reactions; the three who were also positive by the intradermal route were carefully evaluated with a different drug. Eight of the patients with negative skin tests complained of various clinical symptoms after the challenge. All the patients found the local anesthetic to be well tolerated and nobody reported reactions after the clinical use. These results show that skin tests and subcutaneous challenge are safe and sufficient to reliably identify a local anesthetic that patients with a prior history of adverse reaction or at higher risk could tolerate.
局部麻醉药是临床实践中使用最广泛的药物之一。已报道了各种类型的反应，许多患者被告知他们对卡因类药物过敏或有过敏反应的风险。我们报告了386例患者使用皮肤试验和逐步皮下激发试验的经验，以便选择一种可以安全使用的局部麻醉药。患者接受了特定的方案，包括临床病史、点刺试验和皮内试验，以及使用不含防腐剂和血管收缩剂的酰胺类局部麻醉药进行皮下递增激发试验。13例患者皮肤试验呈阳性：10例点刺试验阳性的患者在随后的激发试验中无反应；3例皮内试验也呈阳性的患者用另一种药物进行了仔细评估。8例皮肤试验阴性的患者在激发试验后出现了各种临床症状。所有患者都发现局部麻醉药耐受性良好，临床使用后无人报告有反应。这些结果表明，皮肤试验和皮下激发试验对于可靠地识别有不良反应既往史或高风险患者能够耐受的局部麻醉药是安全且充分的。
