A Case of anaphylaxis due to amide local anesthetics

초록

Although local anesthetics can cause adverse drug reactions (ADRs), most ADRs to local anesthetics are from vasovagal, toxic, or anxiety reactions, and true IgE-mediated anaphylaxis is extremely rare. We report a case of true anaphylactic reaction to lidocaine. A 27-year-old male patient had two episodes of anaphylactic reactions; one after subcutaneous injection of lidocaine to foot, the other after gingival injection of lidocaine for dental treatment. He was referred to our clinic for safe use of local anesthetics for subsequent dental procedure. Skin prick and intradermal tests were performed with amide local anesthetics; lidocaine, bupivacaine, mepivacaine, and ropivacaine. Lidocaine and mepivacaine showed positive response in skin prick test, and lidocaine, mepivacaine, and bupivacaine showed positive reactions in intradermal test. Only ropivacaine showed negative response both in prick and in intradermal test, and no adverse reaction was noted after subcutaneous injection of testing dose of ropivacaine. We recommended ropivacaine for the dental procedures, and the patient was successfully treated with it. This case suggests that local anesthetics can elicit IgE-mediated allergic reactions, and both skin prick and intradermal test should be performed in case of suspected IgE-mediated allergic response to local anesthetics.