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

BACKGROUND

The literature includes scarce data on pediatric local anesthetics (LA) allergy and its diagnostic test results.

OBJECTIVE

This study aimed to determine the prevalence of true LA allergy over 30 years.

METHOD: We evaluated clinical data and test results of patients with suspected immediate-type LA allergy.

RESULTS

This study group consisted of 231 children with a median (interquartile-range) age of 9.1 years (6.5-12.9), with a male predominance (57.6%). The majority of reactions occurred during the dental procedures (84.8%). The most common presenting symptoms were mucocutaneous system reactions in 208 patients (90%). A total of 250 SPTs were performed in all 231 patients with the following drugs: Articaine n = 73 (29.2%), Lidocaine n = 71 (28.4%), Prilocaine n = 65 (26%), and Mepivacaine n = 40 (16%). Local anesthetic allergy was confirmed by positive skin tests (1 SPT, 9 IDT) in 10 patients (4.3%), including 8 patients with one LA and 2 patients with two LAs. In patients with true LA allergy, the median age of the reaction was significantly lower (p = .004), whereas the rate of anaphylaxis was found to be higher (p < .001). Multivariate analysis suggested that a symptom of urticaria (OR: 21.724 [95% CI: 3.349-140.934], p = .001, VIF = 1.074), a history of anaphylaxis (OR: 40.690 [95% CI: 5.877-281.747], p < .001, VIF = 1.056), testing with articaine (OR: 34.559 [95% CI: 3.846-310.507], p = .002, VIF = 1.010), and family history of atopy (OR: 9.410 [95% CI: 1.438-61.593], p = .019, VIF = 1.027) were potential risk factors for true LA allergy, although these findings should be interpreted with caution due to the limited number of cases.

CONCLUSION

True LA allergy was detected in 4.3% of patients, slightly higher than reported in the literature. This may be due to our center being a regional referral center and the study population including immediate-type reactions. Despite the widespread use of LA, IgE-mediated allergy is less common than expected but not rare.