Allergy to local anaesthetic agents used in dentistry – what are the signs, symptoms, alternative diagnosis and management options?

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Publisher: North West Medicines Information Centre

Keywords: Anaesthetics-local; Cross Reactions; Drug Hypersensitivity; Dentistry-operative;

Date published: 29/06/2010 00:00

Review date: 30/06/2012 00:00

Summary

by: Simone Henderson

Allergy to amide local anaesthetics is rare. Allergic reactions are most likely to occur with the ester local anaesthetic agents; these are not used routinely in dentistry.
Adverse effects experienced after administration of local anaesthetics may be mistaken for allergic reactions, but often there is another explanation for the symptoms.
True allergic reactions to local anaesthetics are either immediate (type I; angioedema, urticaria, pruritus, tightness of the chest, wheezing, fall in blood pressure) or delayed (type IV; localised reaction at the injection site, contact dermatitis) hypersensitivity reactions.
Due to the rarity of local anaesthetic allergy, if a patient experiences signs and symptoms suggestive of an allergic response, consideration should be given to other possible causes of the symptoms e.g. toxicity (sedation, light headedness, slurred speech, mood alteration, diplopia, disorientation and muscle twitching) or a psychogenic reaction (anxiety, flushing of the skin, blotchy red rash, bronchospasm, sweating, tachycardia, syncope, hyperventilation, nausea and vomiting).
Where local anaesthetic allergy is strongly suspected, patients should be referred for allergy testing for confirmation.

About this library entry

Category: 15.2 Local anaesthesia | Adverse Drug Reactions | Dentistry | FAQs

NeLM area: Evidence > Medicines Q & A