Allergy Asthma Respir Dis.  2013 Mar;1(1):98-101. 10.4168/aard.2013.1.1.98.

Lidocaine anaphylaxis and lidocaine-specific immunoglobulin E measurement

• Yeo JY
• Kim GE
• Han JY
• Im JH
• Park SW
• Kim CW

• KMID: 2263068
• DOI: http://doi.org/10.4168/aard.2013.1.1.98

Abstract

Although local anesthetics can cause adverse drug reactions (ADRs), most ADRs to local anesthetics are from vasovagal, toxic, or anxiety reactions, while immunoglobulin E (IgE)-mediated anaphylaxis is extremely rare. We report a case of IgE-mediated anaphylactic reaction to lidocaine. A 27-year-old male patient who had two episodes of anaphylactic reactions after local injection of lidocaine was referred to our clinic for the safe use of local anesthetics for the subsequent dental procedure. Skin prick and intradermal tests were performed with amide local anesthetics; lidocaine, bupivacaine, mepivacaine, and ropivacaine. Lidocaine and mepivacaine showed positive response in prick test, and lidocaine, mepivacaine, and bupivacaine showed positive reactions in intradermal test. Only ropivacaine showed negative response both in prick and in intradermal test, and the patient was successfully treated with it. To detect serum-specific IgE, we prepared lidocaine-human serum albumin (HSA) conjugate. Enzyme-linked immunosorbent assay result showed high level of specific IgE to lidocaine-HSA conjugate in serum of the patient. This case suggests that local anesthetics can elicit specific IgE-mediated allergic reactions, and both skin prick and intradermal test should be performed in case of suspected IgE-mediated allergic response to local anesthetics.

Keyword

Anaphylaxis; Specific IgE antibody; Lidocaine

MeSH Terms

Amides
Anaphylaxis
Anesthetics, Local
Anxiety
Bupivacaine
Drug Toxicity
Enzyme-Linked Immunosorbent Assay
Humans
Hypersensitivity
Immunoglobulin E
Immunoglobulins
Intradermal Tests
Lidocaine
Male
Mepivacaine
Serum Albumin
Skin
Amides
Anesthetics, Local
Bupivacaine
Immunoglobulin E
Immunoglobulins
Lidocaine
Mepivacaine
Serum Albumin

Figure

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  Fig. 1 Serum-specific immunoglobulin E (IgE) antibodies to lidocaine-human serum albumin (HSA) conjugate in sera of the patient and 20 healthy controls. Dashed line indicates the positive cut-off value of specific IgE to lidocaine-HSA conjugate (mean+3standard deviation of the absorbance values from healthy controls).

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