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True Allergy to Amide Local Anesthetics: A Review and Case Presentation
Babak BinaDMD, FACD, FICD, FPFA,
Elliot V. HershDMD, MS, PhD,
Micael HilarioDDS,
Kenia AlvarezDMD, and
Bradford McLaughlinDDS
Article Category: Research Article
Volume/Issue: Volume 65: Issue 2
Online Publication Date: Jan 01, 2018
DOI: 10.2344/anpr-65-03-06
Page Range: 119 – 123

Reports of adverse reactions to local anesthetics are usually attributed to a reaction to epinephrine, vasovagal syncope, or overdose toxicity. Patients may then interpret adverse reactions as an allergy to local anesthetic. True allergy to amide local anesthetics is considered to be rare. 1 All injectable local anesthetics are composed of 3 different structural parts: (a) an aromatic or lipophilic portion, necessary for the drug to penetrate the lipid-rich nerve membrane; (b) an amino terminus, ensuring solubility in aqueous medium

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Figure 3. ; Managing history of penicillin allergy.
Daniel E. Becker
<bold>Figure 3.</bold>
Figure 3.

Managing history of penicillin allergy.

Drug Allergies and Implications for Dental Practice
Daniel E. BeckerDDS
Article Category: Other
Volume/Issue: Volume 60: Issue 4
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.4.188
Page Range: 188 – 197

generally unpredictable. They include drug intolerance and idiosyncrasy but mostly embrace drug allergy and other events that resemble allergy, ie, pseudoallergy. It is important to distinguish these categories of drug reactions because patients often report any adverse event as an “allergy.” PATHOGENESIS OF ALLERGY Allergic reactions are immune mediated, generally triggered by lymphocytes. Gell and Coombs 2 first categorized allergic reactions as class I through IV, based on distinct pathologic mechanisms ( Table 1 ). This system still serves

Benzodiazepine Allergy With Anesthesia Administration: A Review of Current Literature
Elliot HaybargerDMD,
Andrew S. YoungDDS, and
Joseph A. Giovannitti JrDMD
Article Category: Research Article
Volume/Issue: Volume 63: Issue 3
Online Publication Date: Jan 01, 2016
DOI: 10.2344/16-00019.1
Page Range: 160 – 167

. Benzodiazepines are sedative hypnotic agents that have been in clinical use since the 1960s for sedation, anterograde amnesia, anxiolysis, as well as treatment of seizures, substance withdrawal states, insomnia, and drug-associated agitation. Allergic reactions are rare, with few cases reported in literature. 3 , 4 Amid these sparse reports, a lack of consistent methods for diagnosis stimulates investigation into identification of the causative agent and classification of the observed reactions. BENZODIAZEPINE ALLERGY: REVIEW OF LITERATURE A

Figure 1; Algorithm for managing patients who claim allergy to local anesthetics. If allergist referral is elected, items included in the arrowed box are reasonable requests for testing. (Adapted from deShazo RD, Kemp SF. JAMA. 1997;278:1903.)
Daniel E. Becker
Figure 1
Figure 1

Algorithm for managing patients who claim allergy to local anesthetics. If allergist referral is elected, items included in the arrowed box are reasonable requests for testing. (Adapted from deShazo RD, Kemp SF. JAMA. 1997;278:1903.)

Figure 1. ; Managing history of local anesthetic allergy. Carefully question the patient regarding the nature of the reaction. If allergist referral is elected, discuss the case history with the physician and request testing for plain lidocaine, which the allergist has available, along with plain prilocaine or mepivacaine, which you will need to provide. (Epinephrine cannot be included, as it inhibits autacoids and renders any testing invalid.) Also address the possibility of bisulfite allergy.
Daniel E. Becker
<bold>Figure 1.</bold>
Figure 1.

Managing history of local anesthetic allergy. Carefully question the patient regarding the nature of the reaction. If allergist referral is elected, discuss the case history with the physician and request testing for plain lidocaine, which the allergist has available, along with plain prilocaine or mepivacaine, which you will need to provide. (Epinephrine cannot be included, as it inhibits autacoids and renders any testing invalid.) Also address the possibility of bisulfite allergy.

Figure 1. ; Structures of lidocaine and diphenhydramine.
Babak Bina,
Elliot V. Hersh,
Micael Hilario,
Kenia Alvarez, and
Bradford McLaughlin
<bold>Figure 1.</bold>
Figure 1.

Structures of lidocaine and diphenhydramine.

Figure 2. ; X-rays.
Babak Bina,
Elliot V. Hersh,
Micael Hilario,
Kenia Alvarez, and
Bradford McLaughlin
<bold>Figure 2.</bold>
Figure 2.

X-rays.

Figure 3. ; Photograph of patient who received 8 mL of 1% diphenhydramine plus 1:100,000 epinephrine. Note the swelling on her right cheek.
Babak Bina,
Elliot V. Hersh,
Micael Hilario,
Kenia Alvarez, and
Bradford McLaughlin
<bold>Figure 3.</bold>
Figure 3.

Photograph of patient who received 8 mL of 1% diphenhydramine plus 1:100,000 epinephrine. Note the swelling on her right cheek.

Figure 4. ; Aspirating Becton Dickinson syringes.
Babak Bina,
Elliot V. Hersh,
Micael Hilario,
Kenia Alvarez, and
Bradford McLaughlin
<bold>Figure 4.</bold>
Figure 4.

Aspirating Becton Dickinson syringes.