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Delayed-type hypersensitivity to lidocaine.

Christine L Mackley1, James G Marks, Bryan E Anderson

  • 1Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. cmackley@psu.edu

Archives of Dermatology
|March 8, 2003
PubMed
Summary
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Delayed-type hypersensitivity to lidocaine, a common anesthetic, may be more frequent than previously believed. Patch testing and intradermal challenges can confirm lidocaine allergy, guiding alternative anesthetic choices.

Area of Science:

  • Dermatology
  • Allergology
  • Anesthesiology

Background:

  • Lidocaine hydrochloride is a widely used local anesthetic in outpatient surgery.
  • While Type I hypersensitivity to lidocaine is rare, Type IV (delayed-type) hypersensitivity is considered even less common.

Observation:

  • A study tested 183 patients for contact dermatitis, with 4 showing positive reactions to lidocaine.
  • Two of these patients had a history of dermatitis following local lidocaine injections.
  • Positive patch tests were confirmed with intradermal lidocaine challenges.

Findings:

  • The study suggests that delayed-type hypersensitivity to lidocaine might be more prevalent than previously recognized.
  • Patch testing is a valuable tool for diagnosing lidocaine Type IV hypersensitivity.

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Implications:

  • Positive patch tests for lidocaine allergy should be confirmed with intradermal testing.
  • Testing alternative injectable anesthetics is crucial for patients with confirmed lidocaine sensitivity.
  • This diagnostic approach aids in selecting safe anesthetic alternatives for hypersensitive patients.