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. 2025 Aug;36(8):e70178.
doi: 10.1111/pai.70178.

Thirty years' experience with immediate-type local anesthetic hypersensitivity reactions in children

Melike Ocak  1 , Fatma Bal Çetinkaya  1 , Ayşegül Akarsu  1 , Deniz İlgün Gürel  1 , Hilal Ünsal  1 , Elif Soyak Aytekin  1 , Umit Murat Sahiner  1 , Bulent Enis Sekerel  1 , Ozge Soyer  1
Affiliations

Thirty years' experience with immediate-type local anesthetic hypersensitivity reactions in children

Melike Ocak et al. Pediatr Allergy Immunol. 2025 Aug.

Abstract

Background: The literature includes scarce data on pediatric local anesthetics (LA) allergy and its diagnostic test results.

Objective: This study aimed to determine the prevalence of true LA allergy over 30 years.

Method: We evaluated clinical data and test results of patients with suspected immediate-type LA allergy.

Results: This study group consisted of 231 children with a median (interquartile-range) age of 9.1 years (6.5-12.9), with a male predominance (57.6%). The majority of reactions occurred during the dental procedures (84.8%). The most common presenting symptoms were mucocutaneous system reactions in 208 patients (90%). A total of 250 SPTs were performed in all 231 patients with the following drugs: Articaine n = 73 (29.2%), Lidocaine n = 71 (28.4%), Prilocaine n = 65 (26%), and Mepivacaine n = 40 (16%). Local anesthetic allergy was confirmed by positive skin tests (1 SPT, 9 IDT) in 10 patients (4.3%), including 8 patients with one LA and 2 patients with two LAs. In patients with true LA allergy, the median age of the reaction was significantly lower (p = .004), whereas the rate of anaphylaxis was found to be higher (p < .001). Multivariate analysis suggested that a symptom of urticaria (OR: 21.724 [95% CI: 3.349-140.934], p = .001, VIF = 1.074), a history of anaphylaxis (OR: 40.690 [95% CI: 5.877-281.747], p < .001, VIF = 1.056), testing with articaine (OR: 34.559 [95% CI: 3.846-310.507], p = .002, VIF = 1.010), and family history of atopy (OR: 9.410 [95% CI: 1.438-61.593], p = .019, VIF = 1.027) were potential risk factors for true LA allergy, although these findings should be interpreted with caution due to the limited number of cases.

Conclusion: True LA allergy was detected in 4.3% of patients, slightly higher than reported in the literature. This may be due to our center being a regional referral center and the study population including immediate-type reactions. Despite the widespread use of LA, IgE-mediated allergy is less common than expected but not rare.

Keywords: allergy; children; drug hypersensitivity reactions; local anesthetics; skin tests.

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References

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