Is local anaesthetic drug allergy really common? A 10-year single-centre retrospective analysis

True allergic reactions to local anaesthetic (LA) agents are extremely rare, yet patients are frequently referred to allergy clinics with a history suggestive of LA hypersensitivity. This study aimed to evaluate the clinical characteristics, risk factors, and diagnostic outcomes of patients referred with suspected LA hypersensitivity.

We retrospectively reviewed all patients evaluated for suspected LA hypersensitivity between 2014 and 2025 in a tertiary allergy centre. Demographic, clinical and laboratory data, including comorbid allergic diseases, total IgE, eosinophil count and serum tryptase levels, were analysed. All patients underwent standardised skin testing and, when indicated, subcutaneous provocation testing with preservative-free LA agents. Logistic regression was used to identify independent predictors of LA hypersensitivity history.

A total of 149 patients (mean age 46.7 ± 13.9 years; 83.9% females) were included. No confirmed cases of IgE-mediated LA hypersensitivity were detected. The most common comorbidities were atopy (50.0%), asthma (24.3%) and allergic rhinitis (34.4%). True LA hypersensitivity was not confirmed in any case; however, at least one safe agent was identified in 83.2% of patients, most frequently lidocaine (63.8%). In multivariate analysis, age was the only independent predictor of reporting LA hypersensitivity (Odds ratio (OR) = 1.02; P = 0.039). Atopy (OR = 0.36; P < 0.001) and asthma (OR = 0.28; P < 0.001) were found to be negative predictors, possibly reflecting referral bias. Multiple drug hypersensitivity was observed in 1.4% of patients, but was not an independent risk factor.

True local anaesthetic hypersensitivity is exceedingly rare. A detailed history combined with appropriate skin and provocation testing prevents unnecessary avoidance of safe agents. Referral bias and overestimation of risk remain common in clinical practice.