True Allergies to Articaine: A 25-Year Analysis

Abstract

Background: Although allergic reactions to amide local anesthetics (LA) are rare, it is important for medical professionals to be aware of their potential occurrence. Despite the fact that articaine is one of the most commonly used LA in dentistry, a survey of documented cases of allergies to articaine is absent from the literature. The objective of this review was to ascertain how often true allergies to articaine, verified by standard allergological procedures, have been reported over the last 25 years. Methods: A comprehensive review of the literature from 1 January 2000 to 31 December 2024 was conducted using the PubMed-MEDLINE database. The search was limited to articles investigating suspected allergy to articaine. The search strategy encompassed indexing terms, keywords, and free-text words, complemented by an extensive manual search. The final determination was based on the application of skin and/or challenge tests as the gold standard for identifying articaine as the causative agent. Results: During the investigation period, 10 case reports and six case series, encompassing 29 patients with a confirmed true allergy to articaine, were identified. The age of the patients ranged from 8 to 65 years, with a median age of 34 years. Of these patients, 20 were diagnosed with an immediate type I allergy, while 5 patients exhibited a delayed type IV allergy. In four cases the specific type of allergy was not mentioned. In the majority of cases an intradermal test (IDT) was employed to ascertain the specific type of allergy. Cross-reactivity with other amide LA was reported in three cases. Conclusions: True allergies to articaine are exceedingly rare. Investigation strategies should include a combination of a thorough clinical history and a standardized allergological procedure entailing skin tests and challenge. Only a comprehensive approach ensures the accurate identification of affected patients and facilitates the selection of a tolerated LA.

Keywords: adverse drug reaction; allergology; challenge test; local anesthesia; skin test.