Immediate reaction to articaine.

A 50-year-old woman was referred from dental clinic to be evaluated for hypersensitivity for articaine. Previously 3 years ago she had urticaria in 10-15 min after administration of a local anaesthetic agent for a dental procedure. She did not know the name of the local anaesthetic agent. For the last 6 years she had been followed with diagnoses of chronic urticaria and angioedema in dermatology department. She was treated with various antihistamines, systemic corticos-teroids, montelukast, azathiopurine and cyclosporine. In her previous examinations she was allergic to house dust mite and autologous serum skin test was found to be negative. She did not report any adverse drug reactions apart from the one she had with local anaesthetic mentioned above. The patient had no family history of allergy. She was on daily levocetirizine therapy for the last 4 months. Skin tests were planned with articaine after cessation of antihistamines for 5 days and provided informed consent for allergologic workup. Positive (histamine) and negative (normal saline solution) controls were also carried out. Skin prick test was negative for articaine HCl/epinephrine HCl (Ultracaine; Sanofi aventis) (1/1). During intradermal test with articaine (1/100) in the tenth minute 30 mm × 30 mm endurance and redness ensued together with globus hyster-icus and paraesthesia in tongue and the test was ended. The physical examination did not reveal any systemic sign of allergic reaction and the symptoms resolved completely in a few minutes without any medical intervention. This result suggested the involvement of a type I allergic reaction. Sub-cutaneous challenge was not performed for ethical reasons since intradermal test with articaine HCl/epinephrine HCl (1/100) was positive. Since no product containing articaine HCl without epinephrine is not available in the market, in order to exclude hypersensitivity to epinephrine, we also performed skin prick and intradermal tests with epinephrine HCl and found negative. Accordingly the patient was evaluated to be allergic to articaine. Afterwards an allergologic workup with prilocaine was planned to determine its safety for the patient. The patient presented negative prick and intradermal test with prilocaine HCl (Citanest; Astra Zeneca). Subcutenous challenge with prilocaine 0.1 ml and 1 ml was performed and came out to be negative and no adverse reactions were observed. In the following day dental procedure was performed successfully without any adverse reaction with prilocaine. Local anaesthetics drugs are widely used since they allow performance of procedures to be safely and comfortably especially in dental …