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Anaphylactic reactions to local anesthetics in dental practice: a nationwide French retrospective study

Abstract

Objectives

The primary aims of the present study were (1) to quantify and characterize anaphylactic type I reactions related to local anesthetics (LAs) drawing on the French Pharmacovigilance Database System over a 35-year period and (2) to focuse on reactions associated with dental procedures. The secondary aim was to infer an incidence rate in dental practice.

Materials and methods

All cases of anaphylactic reactions were selected using the algorithmic Standardized MeDRA Query “anaphylactic reaction.” For each reaction, comprehensive data were collected, in particular the severity of symptoms, risk factors for anaphylaxis, and allergy testing. Imputability was assessed and a crude incidence rate in dental practice was estimated.

Results

The first-line search identified 416 anaphylactic reactions, mostly of grade II (138) or III (240) severity. When restricted to dental practice, this number fell to 26 (grade I: 4; grade II: 10; grade III: 11; and grade IV: 1). Lidocaine was most often involved (81.49%) and mostly associated with anaphylactic reactions of grade II and III. Overall, 11 cases of fatal anaphylaxis were recorded, but no in dental practice. In dental practice, lidocaine was also the most frequently involved LA (57.69%).

Conclusions

All these findings highlight the very low incidence of type I-IgE-mediated reactions to LA, particularly in dental practice. The incidence rate of LA anaphylctic episodes in dental practice was estimated as 0.0261 anaphylactic episodes per million LA cartridges.

Clinical relevance

True anaphylactic reactions to LAs do occur and may justify a thorough investigation in dental practice.

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adapted from Peroni et al. [29]

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Acknowledgements

This work was supported by the French association of regional pharmacovigilance centers representing the French pharmacovigilance centers (which complements the French Pharmacovigilance Database System: FDPS).

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Authors

Contributions

Conceptualization: J. Mahé and P. Lesclous; methodology: J. Mahé; formal analysis and investigations: E. Hascoët and H. Meillard; writing original draft preparation: E. Hascoët and P. Lesclous; writing, review and editing: J. Mahé and A. Cloitre; resources: J. Mahé and H. Théophile; Supervision: J. Mahé and P. Lesclous.

Corresponding author

Correspondence to P. Lesclous.

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The authors declare no competing interests.

Ethics approval

This study was carried out with data of the FDPS, was anonymous and did not require ethical approval according to French legislation.

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Hascoët, E., Mahé, J., Meillard, H. et al. Anaphylactic reactions to local anesthetics in dental practice: a nationwide French retrospective study. Clin Oral Invest (2021). https://doi.org/10.1007/s00784-021-04139-5

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Keywords

  • Anaphylaxis
  • Local anesthetics
  • Dental care
  • Survey