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

Materials and Methods

The results of all patients patch-tested with the NACDG Standard Allergen Tray in our department between January 2001 and December 2005 were reviewed; 1,143 patients were patch-tested according to methods described by the NACDG, with Finn Chambers (Epitest Ltd Oy, Tuusula, Finland) on Scanpor tape (Norgesplaster Aksjeselskap, Vennesla, Norway). The patches remained in place for 48 hours, and readings were performed on day (D)2 or D3 and again on D6 or D7. Patch-test reactions were interpreted and scored as follows: negative (0); macular erythema (?); erythema, infiltration, and possibly papules (+); erythematous papules and/or vesicles (++); and spreading blisters and/or crusting with ulceration (+++).[3,5] Selected patients were patch-tested with additional lidocaine dilutions (10%, 5%, and 1%).

In selected cases, intradermal tests were performed on the inner aspect of the forearm with 0.1 mL each of preservative-free lidocaine 1%,[6] mepivacaine 2%, and bupivacaine 0.5%. Test sites were evaluated at 48 hours for erythema and induration. Relevance of lidocaine hypersensitivity was determined by the patient's history of prior lidocaine exposure. As per NACDG definitions, relevance was defined as “definite” if the reaction to a use test with the putative item containing the suspected allergen or to a patch test with the object or product containing the allergen was positive; “probable” if the substance identified by patch testing could be verified as present in the known skin contactants of the patient; “possible” if the patient was exposed to circumstances in which skin contact with materials known to contain the putative allergen likely occurred;[3] “past” if a positive patch-test reaction could be explained by a previous and unrelated episode of contact dermatitis; and “unknown” if there was no evidence of relevance even after extensive investigations.[7]

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