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Differential diagnosis of late-type reactions to injected local anaesthetics: Inflammation at the injection site is the only indicator of allergic hypersensitivity.
- Source :
-
Contact dermatitis [Contact Dermatitis] 2019 Feb; Vol. 80 (2), pp. 118-124. Date of Electronic Publication: 2018 Oct 11. - Publication Year :
- 2019
-
Abstract
- Background: Anaphylaxis-like reactions developing within a few minutes are the most frequent complications of subcutaneous or submucosal injections of local anaesthetics (LAs), and topically applied LAs are potential contact allergens. In addition, injected LAs have been reported to induce delayed reactions, including local inflammation at the injection site, and various general symptoms.<br />Objectives: To assess the frequency and symptoms of late-type hypersensitivity occurring several hours after LA injections.<br />Methods: We retrospectively evaluated clinical data and test results from all patients referred to our allergy clinic in a period of 20 years for diagnostic work-up of LA-associated late-type reactions.<br />Results: Of 202 patients reporting symptoms with onset at least 1 hour after LA injection, 40 had cutaneous inflammation confined to the injection site, and 162 reported various systemic symptoms. LA hypersensitivity could be excluded in all patients with systemic complaints by means of skin testing and subsequent subcutaneous provocation. In 8 of the 40 patients (20%) with local inflammatory reactions, late-type allergic LA hypersensitivity was confirmed.<br />Conclusions: Late-type LA allergy commonly causes inflammatory skin reactions confined to the injection site. Conversely, LAs are highly unlikely to trigger delayed systemic symptoms such as urticarial or exanthematous skin eruptions.<br /> (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Anaphylaxis chemically induced
Anesthetics, Local administration & dosage
Child
Child, Preschool
Diagnosis, Differential
Drug Eruptions etiology
Drug Hypersensitivity etiology
Drug Hypersensitivity physiopathology
Female
Humans
Hypersensitivity, Delayed chemically induced
Hypersensitivity, Delayed physiopathology
Inflammation
Injection Site Reaction etiology
Injection Site Reaction physiopathology
Injections, Subcutaneous
Male
Middle Aged
Retrospective Studies
Skin Tests
Urticaria chemically induced
Young Adult
Anesthetics, Local adverse effects
Drug Hypersensitivity diagnosis
Hypersensitivity, Delayed diagnosis
Injection Site Reaction diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1600-0536
- Volume :
- 80
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Contact dermatitis
- Publication Type :
- Academic Journal
- Accession number :
- 30311217
- Full Text :
- https://doi.org/10.1111/cod.13130