Drug allergy to local anesthetics: a variety of diagnostic strategies
DOI: 10.32364/2587-6821-2020-4-1-42-47
L.L. Lazarenko1,2, D.V. Shabanov3, T.P. Ses’4, T.G. Fedoskova3, A.A. Totolyan1,4
1Pasteur Research Institute of Epidemiology and Microbiology, St. Petersburg,
Russian Federation
2I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation
3NRC Institute of Immunology, Moscow, Russian Federation
4I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg, Russian Federation
Most patients referring to allergists for drug allergy report that local anesthetics are the main causative agents. Local anesthetics can provide a myriad of adverse reactions, i.e., allergic, pseudo-allergic, and toxic. In many patients, toxic effects of preservatives or adrenaline account for local anesthetic intolerance. This paper reviews published data and authors’ experience with various local anesthetic allergy tests, both in vivo (skin tests, provocation tests, saliva allergy tests) and in vitro (allergen-specific IgE and IgG measurement, basophil activation test etc.). Positive skin tests were revealed in 5.4%, specific IgE in 2.9%, and specific IgG in 3%. Measurement of allergy mediators in saliva is a promising tool since in situ fixation of allergic reaction and objectification of the results by highly-sensitive laboratory tests are provided. The choice of laboratory test depends on reaction development term and expected pathogenic mechanism. However, none of the laboratory tests is absolutely reliable in terms of verifying allergy to local anesthetics. A combination of various in vivo and vitro tests improves the efficacy of diagnostic strategies. Despite numerous laboratory tests, allergen-specific IgE and IgG tests and basophil activation test are currently commercially available only.
Keywords: drug allergy, drug hypersensitivity, local anesthetics, diagnostics, in vivo tests, in vitro tests, specific IgE, specific IgG, basophil activation test, skin tests, provocation tests.
For citation: Lazarenko L.L., Shabanov D.V., T.P. Ses’ et al. Drug allergy to local anesthetics: a variety of diagnostic strategies. Russian Medical Review. 2020;4(1):42–47. DOI: 10.32364/2587-6821-2020-4-1-42-47.
About the authors:
1,2Lyudmila L. Lazarenko — MD, PhD, allergist and immunologist, ORCID iD 0000-0002-5324-7395;
3Dmitriy V. Shabanov — MD, PhD, researcher, ORCID iD 0000-0003-2342-8678;
4Tat’yana P. Ses’ — MD, PhD, Professor, ORCID iD 0000-0001-7903-0023;
3Tat’yana G. Fedoskova — MD, PhD, Professor, Head of the Laboratory, ORCID iD 0000-0003-1456-3923;
1,4Areg A. Totolyan — MD, PhD, Professor, Academician of the Russian Academy of Sciences, Director, ORCID iD 0000-0003-4571-8799.
1Pasteur Research Institute of Epidemiology and Microbiology. 14, Mira str., St. Petersburg, 197101, Russian Federation.
2I.I. Mechnikov North-Western State Medical University. 41, Kirochnaya str., St. Petersburg, 191015, Russian Federation.
3NRC Institute of Immunology. 24, Kashirskoe road, Moscow, 115478, Russian Federation.
4I.P. Pavlov First St. Petersburg State Medical University. 6–8, L’va Tolstogo str., St. Petersburg, 197022, Russian Federation.
Contact information: Lyudmila L. Lazarenko, e-mail: lazarenko@list.ru. Financial Disclosure: no authors have a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 02.03.2020.
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