Allergy to multiple local anesthetics

Area of Science:

• Anesthesiology
• Immunology

Background:

• Real allergy to local anesthetics (LA) is exceptionally rare.
• This study focuses on a unique case of anaphylaxis involving multiple LA agents.

Observation:

• A 25-year-old atopic nurse experienced severe anaphylaxis, including rash, tongue edema, and bronchospasm, after undergoing low back pain infiltration with bupivacaine, lidocaine, and methylprednisolone.
• Initial treatment with adrenaline showed a poor response, necessitating intubation and intensive care unit admission.

Findings:

• Skin-prick tests revealed positive reactions to lidocaine (group 2) and procaine (group 1), and bupivacaine (group 2).
• While mepivacaine (group 2) initially showed no reaction, subsequent symptoms like cough and throat pruritus occurred, suggesting cross-reactivity.
• The reaction pattern suggests a possible IgE-mediated mechanism.

Implications:

• This case underscores the possibility of anaphylaxis to multiple local anesthetics, challenging the notion of their rarity.
• It emphasizes the importance of thorough allergy evaluations, including skin testing, for patients with suspected LA hypersensitivity.
• Understanding potential cross-reactivity among different LA groups is crucial for patient safety and effective clinical management.