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.
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%).
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.
True anaphylactic reactions to LAs do occur and may justify a thorough investigation in dental practice.
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Naguib M, Magboul MM, Samarkandi AH, Attia M (1998) Adverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf 18(4):221–250. https://doi.org/10.2165/0000.2018-199818040-00001
Janas-Naze A, Osica P (2019) The incidence of lidocaine allergy in dentists: an evaluation of 100 general dental practitioners. Int J Occup Med Environ Health 32(3):333–339. https://doi.org/10.13075/ijomeh.1896.01235
Thyssen J, Menne T, Ehlberling J, Plaschke P, Johansen JD (2008) Hypersensitivity to local anesthesics: update and proposal of evaluation algorithm. Contact Dermatitis 59(2):69–78. https://doi.org/10.1111/j.1600-0536.2008.01366.x
Sambrook PJ, Smith W, Elijah J, Goss AN (2011) Severe adverse reactions to dental local anesthetics: systemic reactions. Aust Dent J 56:148–163. https://doi.org/10.1111/j.1834-7819.2011.01316.x
Boren E, Teuber SS, Naguwa SM, Gershwin ME (2007) A critical review of local anesthetic sensitivity. Clin Rev Allergy Immunol 32(1):119–128. https://doi.org/10.1007/BF02686088
Gall H, Kaufmann R, Kalveram CM (1996) Adverse reactions to local anesthetics: analysis of 197 cases. J Allergy Clin Immunol 97(4):933–937. https://doi.org/10.1016/s0091-6749(96)80067-4
Rood JP (2000) Adverse reaction to dental local injection: ‘allergy’ is not the cause. Br Dent J 89(7):380–384. https://doi.org/10.1038/sj.bdj.4800776
Amsler E, Flahault A, Mathelier-Fusade P, Aractingi S (2004) Evaluation of re-challenge in patients with suspected Lidocaine allergy. Dermatology 208:109–111
Bhole MV, Manson L, Seneviratne SL, Misbah SA (2012) IgE-mediated allergy to local anesthetics: separating fact from perception: a UK perspective. Br J Anaesth 108(6):903–911. https://doi.org/10.1093/bja/aes162
Klein CE, Gall H (1991) Type IV allergy to amide-type local anaesthetics. Contact Dermatitis 25(1):45–48. https://doi.org/10.1111/j.1600-0536.1991.tb01772.x
Weightman W, Turner T (1998) Allergic contact dermatitis from lignocaine: report of 29 cases and review of the literature. Contact Dermatitis 39(5):265–266. https://doi.org/10.1111/j.1600-0536.1998.tb05928.x
Venemalm L, Degerbeck F, Smith W (2017) IgE-mediated reaction to mepivacaine. J Allery Clin Immunol 12(4):1058–1059. https://doi.org/10.1016/j.jaci.2007.12.1154
Allen G, Chan D, Gue S (2017) Investigation and diagnosis of an immediate allergy to amide local anaesthetic in a paediatric dental patient. Austr Dent J 62(2):241–245. https://doi.org/10.1111/adj.12501
Moore M, Noblet C, Kreft-Jais C, Lagier G, Ollagnier M, Imbs JL (1995) French pharmacovigilance database system: examples of utilisation. Therapie 50:557–562
Brown EG, Wood L, Wood S (1999) The medical dictionary for regulatory activites (MEDRA). Drug Saf 20(2):109–117. https://doi.org/10.2165/00002018-199920020-00002
Mozzicato P (2007) Standardized MeDRA queries Dru Saf 30(7):617–619. https://doi.org/10.2165/00002018-200730070-000029
Tieu C, Breder CD (2018) A critical evaluation of safety signal analysis using algorithmic Standardized MeDRA Queries. Drug Saf 41(12):1375–1385. https://doi.org/10.1007/s40264-018-0706-7
Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A (2006) Second symposium on the definition and management of anaphylaxis. J Allergy Clin Immunol 117:391–397. https://doi.org/10.1016/j.jaci2005.12.1303
Ring J, Messmer K (1977) Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 8009:466–469. https://doi.org/10.1016/s1040-6736(77)9153-55
Begaud B, Evreux JC, Jouglard J, Lagier G (1985) Imputation of the unexpected or toxic effects of drugs. Actualization of the method used in France. Therapie 40:111–118
Ordre national des chirurgiens dentistes: www.ordre-chirurgiens-dentistes.fr/cartographie/ Accessed 10 February 2021
Incaudo G, Schatz M, Patterson R, Rosenberg M, Yamamoto F, Hamburger RN (1978) Administration of local anesthetics to patients with a history of prior adverse reaction. J Allergy 61:339–345
Fuzier R, Lapeyre-Mestre M, Samii K, Montastruc JL (2009) Adverse drug reaction to local anaesthetic. A review of the French pharmacovigilance database. Drug Saf 32(4):345–356. https://doi.org/10.2165/00002018-200932040-00008
Kwon YS, Kwon YI, An DA, Kim IH (1981) A case report of asthmatic breathing with lidocaine. Korean J Anesthesiol 14:492–494
Ismail K, Simpson PJ (1997) Anaphylactic shock following intravenous administration of lignocaine. Acta Anaesthesiol Scand 41(8):1071–1072. https://doi.org/10.1111/j.1399-6576.1997.tb04838.x
Ogunsalu CO (1998) Anaphylactic reaction following administration of lignocaine hydrochloride infiltration. Case report Aust Dent J 43(3):170–171. https://doi.org/10.1111/j.1834-7819.1998.tb00159.x
Lee SM, Song WJ, Yang MS, Lee SH, Kwon JW, Kim TW et al (2006) A case of lidocaine anaphylaxis. Korean J Asthma Allergy Clin Immunol 26:249–251
Fuzier R, Lapeyre-Mestre M, Mertes PM, Nicolas JF, Benoit Y, Didier A, Albert N, Montastruc JL (2009) Immediate and delayed-type allergic reaction to amide local anesthetics: clinical features and skin testing. Pharmacoepidemiol Drug Saf 18(7):595–601. https://doi.org/10.1002/pds.1758
Cuesta-Herranz J, de las Heras M, Fernandez M, Lluch M, Figueredo E, Umpierrez A, Lahoz C, (1997) Allergic reaction caused by local anesthetic agent belonging to the amide group. J Allergy Cin Immunol 99(3):427–428. https://doi.org/10.1016/s.0091-6749(97)70064-2
Campbell JR, Maestrello CL, Campbell RL (2001) Allergic response to metabisulfite in lidocaine anesthetic solution. Anesth Prog 48(1):21–26
Macy E, Schatz M, Zeiger RS (2002) Immediate hypersensitivity to methylparaben causing false-positive results to local anaesthetic skin testing or provocative dise testing. The Permanente Journal 6:4
Ewan PW, Dugué P, Mirakian R, Dixon TA, Harper JN, BSACI, (2010) BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia. Clin Exp Allergy 40(1):15–31. https://doi.org/10.1111/j.1365-2222.2009.03404.x
Peroni D, Pasini M, Lurato C, Cappelli S, Giuca G, Giuca MR (2019) Allergic manifestations to local anaesthetic agents for dental anaesthesia in children: a review and proposal of a new algorithm. Eur J Paediatr Dent 20(1):48–52. https://doi.org/10.23804/ejpd.2019.20.01.10
Simons FE (2011) Anaphylaxis pathogenesis and treatment. Allergy 66:31–34. https://doi.org/10.1111/j.398-9995.2011.02629.x
Bégaud M, Martin K, Haramburu F, Moore N (2002) Rates of spontaneous reporting of adverse drug reactions in France. JAMA 288:1588. https://doi.org/10.1001/jama.288.13.1588
Backstrom M, Mjorndal T, Dahlqvist R (2004) Under-reporting of serious adverse drug reactions in Sweden. Pharmacoepidemiol Drug Saf 13:483–487. https://doi.org/10.2165/00002018-200629050-00003
Hazell L, Shakir SA (2006) Under-reporting of adverse drug reactions: a systematic review. Drug Saf 29:385–396. https://doi.org/10.1002/pds.1758
Erlewyn-Lajeunesse M, Dymnd S, Slade I, Mansfield HL, Fish R, Jones O, Benger JR (2010) Diagnostic utility of two case definitions for anaphylaxis: a comparison using a retrospective case notes analysis in the UK. Drug Saf 33:57–64. https://doi.org/10.2165/1318970-000000000-00000
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).
Conflict of interest
The authors declare no competing interests.
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
- Local anesthetics
- Dental care