Allergy to local anaesthetics in dentistry. Myth or reality?

Baluga, Juan Carlos; Casamayou, Raúl; Carozzi, E.; López, Natalia Blanca; Anale, R.; Borges, Renata Fuentes; Álvarez, E.; Baez, C.; Cedrés, Cecilia; Guelfi, C.; Larrosa, H.; Sassi, R.; Polero, Y.

doi:10.1016/s0301-0546(02)79081-2

Cited by 59 publications

(46 citation statements)

References 19 publications

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“…The main advantage of Articaine is its better haemostatic and bone diffusibility but the drawback of Articaine is paresthesia. There is absolutely no scientific evidence available to support the claim that Articaine is associated with a greater incidence of paresthesia [5,10,11,31]. However further studies on a larger group of population are recommended for greater authenticity of this relatively new drug in oral and maxillofacial surgery in India to make as popular and safer to be used as a routine anesthetic agent in dentistry.…”

Section: Resultsmentioning

confidence: 99%

“…Today it is considered as a reference standard against which other local anesthetic agents are compared. Various studies have been done in dentistry evaluating the safety and efficacy of Articaine [10,11,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Since its introduction in 1969, Articaine has gradually become implanted in Europe.…”

Section: Discussionmentioning

confidence: 99%

“…According to literature Articaine has potential to cause methemeglobinemia, neuropathies, paresthesia [7,14,15,32,38,50], hypersensitivity [28], allergy [29,31]. Malamed et al [8,9] reported overall incidence of adverse events in the combined studies was 22 % for Articaine and 20 % Lidocaine of which paresthesia was 0.9 %, hypoesthesia 0.7 %, headache 0.55 %, infection 0.45 %, rash and pain 0.3 %.…”

Section: Adverse Effectsmentioning

confidence: 99%

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Efficacy of 4 % Articaine and 2 % Lidocaine: A clinical study

Kambalimath¹,

Dolas

Kambalimath

et al. 2012

J. Maxillofac. Oral Surg.

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Objectives This study was undertaken to compare the anesthetic properties of 4 % Articaine hydrochloride and 2 % Lidocaine both with 1:100,000 epinephrine for mandibular inferior alveolar nerve anesthesia. Materials and Methods Thirty healthy patients were included in this randomized double-blind clinical cross over study. Each subject received each test solution at different times. Inferior alveolar nerve block anesthesia was used for extraction of bilateral impacted mandibular third molar on different occassions. The time of onset of action, duration of anesthesia, efficacy of anesthesia, hemodynamic parameters and oxygen saturation were monitored during the procedure. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. Results No statistically significant differences were seen in the onset and duration of anesthesia between the Articaine and Lidocaine solutions. Conclusions 4 % Articaine offers better clinical performance than 2 % Lidocaine, particularly in terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Adverse Effectsmentioning

confidence: 99%

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Efficacy of 4 % Articaine and 2 % Lidocaine: A clinical study

Kambalimath¹,

Dolas

Kambalimath

et al. 2012

J. Maxillofac. Oral Surg.

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“…Immunological reactions to local anaesthetics, particular the newer amides, however, remain anecdotal and symptoms usually result from vasovagal episodes or anxiety reactions (178,(181)(182)(183). Acute disorientation or seizures may occur after overdosage or inadvertent intravenous injection.…”

Section: Local Anaestheticsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

192

197

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Anaesthesiologists administer several drugs while providing general anaesthesia. Many of these drugs can elicit adverse drug reactions that fall apart into two major types. First, reactions that are usually dose-dependent and related to the pharmacological properties of the drug and/or its metabolites. Second, reactions that are unrelated to the drug's pharmacological characteristics and that are less dose-dependent. These reactions comprise drug intolerance, idiosyncratic reactions and drug-induced immune-mediated allergic and nonimmune-mediated so-called pseudo-allergic or anaphylactoid reactions. The terms anaphylactic and anaphylactoid, however, have been used inconsistently in the literature. Therefore, the nomenclature task force set up by the European Academy of Allergy and Immunology (EAACI) has proposed that anaphylactic-type reactions should be reclassified into allergic anaphylaxis and nonallergic anaphylaxis. Allergic anaphylaxis being further subdivided in IgE-mediated and non-IgE-mediated reactions (1).The exact prevalence of anaphylaxis during anaesthesia is difficult to ascertain. The estimated overall frequency has been reported to vary between 1 in 3500 and 1 in 13 000 procedures in French series (2, 3) and between 1 in 10 000 and 1 in 20 000 in an Australian study (4). The clinical manifestation of these reactions is not infrequently an almost immediate generalized response with bronchospasm and hypotension. The degree of severity varies and does not allow differentiation between an IgE-mediated or non-IgE mediated reaction resulting from nonspecific mediator release (5). The mortality from these reactions is in the range from 3 to 6%, and an additional 2% of patients experience significant residual brain damage (4).Diagnosis of anaphylaxis during anaesthesia is not always straightforward. It can be hampered as a broad spectrum of different drugs can elicit heterogeneous allergic and nonallergic reactions with distinct and sometimes unclear pathological mechanisms. Problems are certainly compounded as multiple drugs need to be administered during general anaesthesia. In addition, nonanaesthesia related drugs or procedures (e.g. disinfection) are sometimes administered/performed in the perioperative period and can also be the cause of an allergic reaction.In addition, none of the available diagnostic tests demonstrates absolute accuracy. False-positive test Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds.However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done.This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the di...

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“…Indeed, it has been suggested that true allergic reactions to local anaesthetics do not occur or are a myth. 8 However, there are multiple single-case reports of individual cases in the literature. [9][10][11][12][13] It has been estimated that true immunologic adverse reactions occur in approximately 1% of all adverse systemic reactions.…”

Section: Introductionmentioning

confidence: 99%

Severe adverse reactions to dental local anaesthetics: systemic reactions

Sambrook

Smith

Elijah³

et al. 2011

Australian Dental Journal

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Background: Occasionally, patients suffer systemic adverse effects from injections of local anaesthetic solutions. This may range from minor transient vasovagal attacks to life-threatening collapse. Methods: The suspected adverse reactions reported to the Office of Product Review of the Therapeutic Goods Administration (TGA) were analysed in detail.Results: There was a high incidence (70%) of adverse reactions associated with prilocaine, which is much greater than its market share (less than 20%). There is a tendency to consider all systemic adverse reactions as being 'allergic' reactions although this is rarely the case. Syncope, cardiovascular and central nervous system reactions are much more common. There is also a risk of methaemoglobinaemia to prilocaine and articaine. A small series of cases referred to one of the authors were also reported. Conclusions: Recommendations are made as to the prevention, acute care and subsequent investigation of adverse reactions. The most important conclusion is not to just label the response as allergic and to use an alternative agent. Detailed investigation and reporting should be made for all cases of suspected severe adverse reaction to local anaesthetic agents.

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Allergy to local anaesthetics in dentistry. Myth or reality?

Cited by 59 publications

References 19 publications

Efficacy of 4 % Articaine and 2 % Lidocaine: A clinical study

Efficacy of 4 % Articaine and 2 % Lidocaine: A clinical study

Anaphylaxis during anaesthesia: diagnostic approach

Severe adverse reactions to dental local anaesthetics: systemic reactions

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