Evaluation and management of hypersensitivity to local anesthetics in pediatric dentistry

The clinical histories of four children with a history of adverse reactions to local anesthesia and who required dental treatment are reviewed retrospectively. The children described had been referred to the allergy unit for evaluation between 1984 and 1985 and are representative of the dilemma of cases of suspected hypersensitivity to local anesthetics. The first two cases had been previously treated without the use of regional anesthesia because of a family history of atopic reactions as well as equivocal skin testing to local anesthetic. The third child had experienced bizarre adverse reactions to a variety of foods and detergents erroneously interpreted as possible deterrents to the use of local anesthetics. All four children were challenged with progressively increasing concentrations of lidocaine according to a described protocol. In three cases no reaction was observed and dental procedures were performed without difficulty using lidocaine for local anesthetics. A history of bronchoconstriction in the fourth child and the contradictory results of skin tests to local anesthetics, prompted the administration of pretreatment medication aimed at preventing bronchial hyperactivity related to dental anesthesia.