Risk of True Allergy to Local Anesthetics: 10-Year Experience from an Anesthesia Allergy Clinic in China

Figures & data

Table 1 Maximum Concentrations of LAs in the Skin Tests and BAT

LAs	Original(mg/mL)	SPT (mg/mL)	IDT (mg/mL)	BAT (mg/mL)
Procaine	20	20	2	1
Lidocaine	10	10	1	0.125
Bupivacaine	2.5	2.5	0.25	0.5
Ropivacaine	2	2	0.2	1
Articaine	40	40	4	1

Figure 1 Flowchart of patients evaluated for allergy to LAs.

Abbreviation: n, number of patients.

Table 2 Demographics of the Population Included in the Analysis

Variables	Total, n (%)	Suspected DHR to LAs	History of DHR to Other Drugs
Study population	109	68 (62%)	41 (38%)
Female/male	85 (78%)/24 (22%)	59 (87%)/9 (13%)	26 (63%)/15 (37%)
Age, mean (range)	42 (6–78)	43 (22–78)	40 (6–77)
History of any other allergic diseases	48 (44%)	32 (47%)	16 (39%)
The testing procedures
Skin tests	99 (91%)	58 (85%)	41 (100%)
BAT	103 (94%)	62 (91%)	41 (100%)

Table 3 Clinical Characteristics of 68 Patients with a Suspected DHR to LAs

Variables	n (%)
Suspected LAs	68
Procaine	4 (6%)
Articaine	5 (7%)
Lidocaine	31 (46%)
Ropivacaine	2 (3%)
Bupivacaine	1 (1%)
Unknown	25 (37%)
Symptoms of drug reactions
Cutaneous	22 (32%)
Rash	15 (22%)
Flushing, erythema	4 (6%)
Urticaria or angioedema	3 (4%)
CNS	21 (31%)
Anxiety, malaise, sweating	11 (16%)
Dizziness	4 (6%)
Somnolence, syncope or loss of consciousness	8 (12%)
Circulatory	31 (46%)
Palpitations, tachycardia	15 (22%)
Hypotension	7 (10%)
Shock or cardiac arrest	13 (20%)
Respiratory	19 (28%)
Chest tightness, dyspnea, wheezing	16 (24%)
Bronchospasm	3 (4%)
Others	8 (12%)
Treatment
Adrenaline	15 (22%)
Others	40 (59%)
No specified treatment	13 (19%)
Outcomes
The planned procedures were completed	38 (56%)
Postponed for another procedures	25 (37%)
Unknown	5 (7%)

Table 4 Overview of 41 Patients with a History of DHR to Other Drugs

Variables	n (%)
History of DHR to other drugs	41
General anesthetics	25 (61%)
Antibiotics	9 (22%)
NSAIDs	2 (5%)
Radiocontrast agent	1 (2%)
Others	4 (10%)
Requested LAs
Lidocaine	22 (54%)
Ropivacaine	4 (10%)
Unknown (Lidocaine was tested)	15 (36%)

Table 5 Clinical Data of Six Patients with Test Positivity to LAs

No.	Age	Gender	Procedure	Clinical Characteristics	Culprit Drug	Skin Tests	BAT
1	34	F	Surgery	Hypotension, palpitations, shock, angioedema	Ropivacaine	Positive	Positive
2	25	F	Dentistry	Hypotension, palpitation, dizziness, dyspnea, somnolence	Lidocaine	Positive	Negative
3	52	F	Surgery	Hypotension, rash	Ropivacaine	Positive	Negative
4	75	F	Surgery	Tachycardia, malaise, syncope	Lidocaine	Positive	Negative
5	25	F	Dentistry	Dizziness, angioedema	Lidocaine	Positive	Positive
6	29	F	Dentistry	Hypotension, rash	Lidocaine	Not done	Positive