Contact Allergy to Lidocaine: A Report of Sixteen Cases

Antoine Amado; Apra Sood; James S. Taylor

Disclosures

Dermatitis. 2007;18(4):215-220. 

In This Article

Abstract and Introduction

Abstract

Lidocaine is used widely as an injectable local anesthetic, occasionally as an intravenous drug for cardiac arrhythmias, and increasingly as a topical anesthetic. Reports of allergic contact dermatitis and delayed hypersensitivity reactions to this “amide” anesthetic are limited. We report 16 cases of lidocaine contact allergy seen over 5 years. Concomitant patch-test reactions occurred with neomycin 20% (10 cases), bacitracin 20% (9 cases), fragrance mix 8% (3 cases), balsam of Peru 25% (2 cases), and dibucaine 2.5% and benzocaine 5% (1 case each). Patch tests with lidocaine dilutions (in petrolatum) gave the following results: 10% (3 of 4 positive reactions), 5% (4 of 6 positive reactions), and 1% (3 of 6 positive reactions). Intradermal testing with lidocaine 1%, mepivacaine 2%, and bupivacaine 0.5% was performed on 8 patients, resulting in positive reactions to lidocaine in 3 patients and to mepivacaine in 1 patient. Bupivacaine yielded negative results in each of the 8 patients. Relevance of delayed reactions to injectable lidocaine was definite in 2 cases; past, probable, and unknown in 1 case each; and possible in 11 cases. Delayed hypersensitivity to lidocaine may present as “suture allergy,” treatment failure, typical contact allergy, or other local skin or dental reactions. Allergen substitution is based on further patch and intradermal testing, the results of which may be discordant.

Introduction

THE USE OF CHEMICAL SUBSTANCES for preventing or treating local pain has its origin in South America. For centuries, coca leaves (Erythroxylon coca) have been chewed by Andean natives to prevent hunger and to increase endurance. In 1860, cocaine was isolated by Nieman, who noted that it caused a numbing of the tongue. But it was not until 1884 that cocaine was introduced clinically and not until 1905 that procaine was introduced as the first safe local anesthetic. The major breakthrough in the chemistry of local anesthetic agents occurred in 1943, when Loefgren synthesized lidocaine, an amide derivative of diethylamino acid.[1]

Nearly 2 million injections of local anesthetics are given daily in the United States.[2] True immunologic reactions to a local anesthetic are rare and account for less than 1% of all adverse reactions to these preparations.[1] Lidocaine is widely used as an injectable local anesthetic (intravenously for cardiac arrhythmias) and as a topical anesthetic. Reports of allergic contact dermatitis (ACD) and delayed hypersensitivity reactions to this “amide” anesthetic are even more limited. Lidocaine 15% was added to the North American Contact Dermatitis Group (NACDG) Standard Allergen Tray in 2001,[3] after an Australian study reported 29 cases of ACD from lignocaine (lidocaine).[4]

Comments

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