Open Access, Peer-reviewed
pISSN 2288-0402
eISSN 2288-0410
    Allergy Asthma Respir Dis. 2014 Sep;2(4):298-301. Korean.
    Published online Sep 30, 2014.
    https://doi.org/10.4168/aard.2014.2.4.298
    © 2014 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
    Case Report

    Delayed urticaria caused by lidocaine in a child

    Geun-Mi Park,1 Hae Won Han,1 Jae Yeon Kim,1 Keum Hee Hwang,2 Eun Lee,3 Song-I Yang,3 Young-Ho Jung,3 Soo-Jong Hong,3 Ju-Hee Seo,4 and Jinho Yu3
      • 1Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
      • 2Special Exam Service, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
      • 3Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
      • 4Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
    • Correspondence to: Jinho Yu. Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3922, Fax: +82-2-473-3725, Email: jyu3922@gmail.com
    Received December 12, 2013; Revised February 25, 2014; Accepted March 10, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

    Abstract

    Lidocaine is a commonly used local anesthetic for dental treatment. Urticaria caused by lidocaine has seldom been reported. Generally, urticaria immediately develops after exposure to a causative agent and is considered a manifestation of IgE-mediated hypersensitivity. However, delayed urticaria caused by local anesthetics was reported to be related to cell mediated hypersenstivity. A 3-year old girl visited our allergy clinic due to delayed urticaria after local administration of lidocaine. Both skin prick and intradermal tests with lidocaine revealed negative reactions. However, the provocation test with subcutaneous injection of lidocaine showed urticaria 7 hours after test. In order to identify alternative local anesthetic for the subsequent dental procedure, we performed skin prick, intradermal and provocation tests with procaine, a local anesthetic of the other class, all of which showed negative results. Therefore, we recommended procaine as an alternative local anesthetic, and the patient was successfully treated with procaine. To the best of our knowledge, this is the first case of delayed urticaria caused by lidocaine in Korea.

    Keywords
    Lidocaine; Local anesthetic; Urticaria; Adverse drug reaction

    Tables

    Table 1
    The results of skin prick test and intradermal test for local anesthetics

    Table 2
    Classes of local anesthetics

    References

      1. Berkun Y, Ben-Zvi A, Levy Y, Galili D, Shalit M. Evaluation of adverse reactions to local anesthetics: experience with 236 patients. Ann Allergy Asthma Immunol 2003;91:342–345.
      1. Gall H, Kaufmann R, Kalveram CM. Adverse reactions to local anesthetics: analysis of 197 cases. J Allergy Clin Immunol 1996;97:933–937.
      1. Mertes PM, Laxenaire MC. Allergic reactions occurring during anaesthesia. Eur J Anaesthesiol 2002;19:240–262.
      1. Schatz M. Skin testing and incremental challenge in the evaluation of adverse reactions to local anesthetics. J Allergy Clin Immunol 1984;74(4 Pt 2):606–616.
      1. Lee SM, Song WJ, Yang MS, Lee SH, Kwon JW, Kim TW, et al. A case of lidocaine anaphylaxis. Korean J Asthma Allergy Clin Immunol 2006;26:249–253.
      1. Yeo JY, Kim GE, Han JY, Im JH, Park SW, Kim CW. Lidocaine anaphylaxis and lidocaine-specific immunoglobulin E measurement. Allergy Asthma Respir Dis 2013;1:98–101.
      1. Thyssen JP, Menne T, Elberling J, Plaschke P, Johansen JD. Hypersensitivity to local anaesthetics: update and proposal of evaluation algorithm. Contact Dermatitis 2008;59:69–78.
      1. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez J, et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003;58:854–863.
      1. Naguib M, Magboul MM, Samarkandi AH, Attia M. Adverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf 1998;18:221–250.
      1. Schwartz HJ, Sher TH. Bisulfite sensitivity manifesting as allergy to local dental anesthesia. J Allergy Clin Immunol 1985;75:525–527.
      1. Primeau MN, Adkinson NF Jr, Hamilton RG. Natural rubber pharmaceutical vial closures release latex allergens that produce skin reactions. J Allergy Clin Immunol 2001;107:958–962.
      1. Vu AT, Lockey RF. Benzocaine anaphylaxis. J Allergy Clin Immunol 2006;118:534–535.
      1. Curley RK, Macfarlane AW, King CM. Contact sensitivity to the amide anesthetics lidocaine, prilocaine, and mepivacaine. Case report and review of the literature. Arch Dermatol 1986;122:924–926.
      1. Klein CE, Gall H. Type IV allergy to amide-type local anesthetics. Contact Dermatitis 1991;25:45–48.
      1. Prieto A, Herrero T, Rubio M, Tornero P, Baeza ML, Velloso A, et al. Urticaria due to mepivacaine with tolerance to lidocaine and bupivacaine. Allergy 2005;60:261–262.
      1. McClimon B, Rank M, Li J. The predictive value of skin testing in the diagnosis of local anesthetic allergy. Allergy Asthma Proc 2011;32:95–98.
      1. Fuzier R, Lapeyre-Mestre M, Mertes PM, Nicolas JF, Benoit Y, Didier A, et al. Immediate- and delayed-type allergic reactions to amide local anesthetics: clinical features and skin testing. Pharmacoepidemiol Drug Saf 2009;18:595–601.
      1. Sanico AM, Saini SS. Immediate hypersensitivity: approach to diagnosis. In: Adelman DC, Casale TB, Corren J, editors. Manual of Allergy and immunology. 4th ed. Philadelphia: Lippincott, Williams & Wilkins; 2002. pp. 24-43.
      1. Pichler WJ, Naisbitt DJ, Park BK. Immune pathomechanism of drug hypersensitivity reactions. J Allergy Clin Immunol 2011;127 3 Suppl:S74–S81.
      1. Orasch CE, Helbling A, Zanni MP, Yawalkar N, Hari Y, Pichler WJ. T-cell reaction to local anaesthetics: relationship to angioedema and urticaria after subcutaneous application--patch testing and LTT in patients with adverse reaction to local anaesthetics. Clin Exp Allergy 1999;29:1549–1554.
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    MeSH Terms
    Anesthetics, Local
    Child*
    Drug-Related Side Effects and Adverse Reactions
    Female
    Humans
    Hypersensitivity
    Hypersensitivity, Immediate
    Injections, Subcutaneous
    Intradermal Tests
    Korea
    Lidocaine*
    Procaine
    Skin
    Urticaria*
    Metrics
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