Stress-induced urticaria associated with local anesthetic administration

A case is reported in which chronic urticaria developed following local anesthetic administration in a 21-year old Chinese-American male who had presented for routine dental care. An in-depth medical history and intradermal skin-testing failed to disclose a reason for this reaction. Referral to an allergist revealed a previously unknown underlying emotional tension which contributed to the development of chronic urticaria. A brief trial of hydroxyzine (Vistaril), an antihistaminic and anxiolytic medication, was successful in controlling this condition. This case illustrates the importance of the evaluation of the emotional status as a vital component of a comprehensive medical history.