Delayed-type hypersensitivity after subcutaneous administration of amide anesthetic

Delayed-Type Hypersensitivity to Lidocaine

“…Whalen 21 reported a patient with a localized, pruritic, vesiculobullous delayed-type hypersensitivity reaction on the dorsum of the hand 12 hours after lidocaine injection. Patch testing confirmed this sensitivity.…”

Use of preservative-free lidocaine for cataract surgery in a patient allergic to “caines”

“…A thorough history including the agent, route of administration, presence of preservative, and temporal relationship between the administration and onset of symptoms is indicated, but commonly will be inconclusive. 6 Understanding a few principles will help the physician sort through the possible etiologies of true allergy and help identify offending agents to avoid in the future and those that are safe for immediate use.…”

“…Since false-negatives are rare, skin testing will often identify agents that can be given safely. 6 Skin testing should be done with and without preservatives. If a preservative is found to be the etiologic agent, we believe that a preservative-free LA can be given safely, as demonstrated in this case.…”