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Thirty years' experience with immediate-type local anesthetic hypersensitivity reactions in children

Melike Ocak1, Fatma Bal Çetinkaya1, Ayşegül Akarsu1

  • 1Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|August 22, 2025
PubMed

Insights

True local anesthetic (LA) allergy is uncommon in children, affecting 4.3% of those with suspected reactions. Key risk factors include urticaria and a history of anaphylaxis, highlighting the need for careful diagnosis.

Area of Science:

  • Allergy and Immunology
  • Pediatric Medicine
  • Pharmacology

Background:

  • Limited data exists on pediatric local anesthetic (LA) allergy.
  • Diagnostic test results for LA allergy in children are scarce in the literature.

Purpose of the Study:

  • To determine the prevalence of true local anesthetic (LA) allergy in pediatric patients over a 30-year period.
  • To identify risk factors associated with true LA allergy in children.

Main Methods:

  • Clinical data and diagnostic test results of 231 children with suspected immediate-type LA allergy were evaluated.
  • Skin prick tests (SPTs) and intradermal tests (IDTs) were performed for various local anesthetics, including articaine, lidocaine, prilocaine, and mepivacaine.

Main Results:

  • True LA allergy was confirmed in 4.3% of the pediatric patients studied.
  • Mucocutaneous reactions were the most common presenting symptom (90%).
  • Risk factors for true LA allergy included urticaria, a history of anaphylaxis, testing with articaine, and a family history of atopy.

Conclusions:

  • True local anesthetic (LA) allergy is diagnosed in 4.3% of pediatric patients, a rate slightly higher than previously reported.
  • While IgE-mediated LA allergy is less common than anticipated given widespread use, it is not rare.
  • Findings suggest specific symptoms and patient history may indicate increased risk for LA allergy in children.
Abstract

Keywords:
allergychildrendrug hypersensitivity reactionslocal anestheticsskin tests

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