Evaluation of diagnostic tests for immediate-type allergic reactions to amide group local anesthetics in children

Abstract

Background: Local anesthetics (LAs) are widely utilized to provide analgesia in minor surgical interventions. Although patients are frequently referred for suspected LA allergies in clinical practice, confirmed cases of immediate-type hypersensitivity remain rare. This study aims to establish an optimal diagnostic protocol for immediate-type LA allergy in children and to assess the practicality and reliability of an alternative diagnostic approach for hypersensitivity testing of amide-type local anesthetics.

Methods: The medical records of patients diagnosed with suspected immediate-type reactions to LAs administered by pediatric dentists between January 2019 and August 2024 were retrospectively reviewed. All children underwent a skin prick test (SPT), followed if negative by an intradermal test (IDT) at a 1:10 dilution. If intradermal testing was also negative, a subcutaneous provocation test was subsequently performed.

Results: A total of 88 patients (47 boys, 41 girls), with a mean age of 8.5 ± 3.5 years, were included. In most cases (n = 59, 67%), the suspected LA was unidentified. Among the known agents, articaine (n = 18, 20.5%) and lidocaine (n = 11, 12.5%) were the most frequently reported. IDT results were positive in 11 patients (12.5%), with articaine in 8 cases (61.5%), prilocaine in 3 cases (23%), and lidocaine in 2 cases (15.5%). Intradermal testing at a 1:10 dilution demonstrated a high negative predictive value (99%) for immediate-type reactions.

Conclusion: For the diagnosis of immediate-type LA allergy, including cases with a history of anaphylaxis, an IDT at a 1:10 dilution following a negative SPT, followed by subcutaneous provocation, may serve as a time-efficient and reliable diagnostic strategy.

Keywords: allergy; children; intradermal test; local anesthetic.

FIGURE 1

Diagnostic Testing Protocol for Local Anesthetic Allergy. LA, Local anesthetic.