Risk Factors for Immediate-Type Local Anesthetic Hypersensitivity Reactions in Pediatric Patients: A Retrospective Case-Control Study

Figures & data

Figure 1 Results of allergic evaluation of the children (patients and controls) with suspected reactions to local anesthetics. Safe LA was determined by skin and drug provocation tests. Mepivacaine and lidocaine were determined as safe local anesthetics in the patient whose skin test was positive with articaine.

Abbreviations: IDT: intradermal test, LA: local anesthetic; SPTs: skin prick tests,

Table 1 Comparison of Clinical Characteristic of the Patients and Matched Controls

	Patients,	Controls,	OR	95% CI	P
	n (%)	n (%)
	n=17	n=51
Clinical manifestations
Urticaria and/or urticaria-angioedema	14 (82.4)	7 (13.7)	29.3	6.7–128.9	<0.001
Anaphylaxis	2
Itchy throat	1
Shortness of breath without cough		13 (25.4)
Suspected vasovagal reactions (pallor, fainting, hypotension)		15 (29.4)
Subjective complaints ^§		16 (31.4)
Presence of more than one LA reactions	4 (23.5)	1 (2)	15.4	1.6–149.6	0.019
Previous LA exposure (≥2)	11 (64.7)	6 (11.8)	13.7	3.7–50.9	<0.001
Latent period^† ≤1 year	13 (76.5)	33 (64.7)	1.8	0.5–6.2	0.373
Confirmed drug allergy, except LA	2 (11.8)	5 (9.8)	1.2	0.2–6.9	0.818
Β-lactam		3
NSAID	2	2
Presence of latex sensitivity in skin tests	0	1
Personal history of atopic disease	4 (23.5)	10 (19.6)	1.3	0.3–4.7	0.729
Food allergy (cow’s milk anaphylaxis)	1	0
Asthma ± allergic rhinitis	3	10
Concomitant chronic diseases	2 (11.8)	4 (2)	1.5	0.3–9.4	0.624
Familial Mediterranean fever	1
Vesicourethral reflux	1
Chronic spontaneous urticaria		3
Cutaneous mastocytosis		1
Family history of drug allergy	3 (17.6)	5 (9.8)	1.9	0.4–9.3	0.391

Notes: Significant P values are presented in bold. ^§ Nausea, feeling unwell. ^† Time elapsed between last LA reaction and current allergic evaluation.

Abbreviations: CI, confidence interval; LA, local anesthetic; NSAID, nonsteroidal anti-inflammatory drug; OR, odds ratio,

Table 2 Risk Factors for Local Anesthetic Hypersensitivity

	Univariate Analysis		Multivariate Analysis
Parameter	Odds Ratio (95% CI)	P	Odds Ratio (95% CI)	P
Presence of cutaneous manifestations	9.1 (2.7–30.7)	<0.001	17.3 (3.6–82.5)	<0.001
Presence of more than one LA reactions	15.4 (1.6–149.6)	0.019	–
Previous exposure to LA (≥2)	13.7 (3.7–50.9)	<0.001	5.7 (1.2–27.1)	0.029

Notes: Nagelkerke R Square: 0.559, Significant P values are presented in bold. -: Not significant.

Abbreviations: CI, confidence interval; LA, local anesthetic; OR, odds ratio.