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

Results

During the study period, 1,143 patients were patch-tested with the NACDG Standard Allergen Tray ( Table 1 and Table 2 ; Figs 1 and 2). The two definitely relevant cases are presented here in more detail.

Figure 1.

Strong patch-test reaction to lidocaine 15% at day 7.

Figure 2.

Positive response to intradermal test with preservative-free lidocaine 1%.

Case 1 (Patient 1)

A 28-year-old woman presented with a history of a postoperative allergic reaction. She had undergone breast augmentation surgery 2 months earlier, during which lidocaine 1% was injected in the periareolar area and the breast pockets were irrigated with bacitracin. Over the next postoperative 2 days, she developed a pruritic vesicobullous generalized rash. On repeated occasions in the past, the patient had developed localized “suture reactions” with vesicles and erythema several millimeters around the sutures each time, occurring 24 to 35 hours after surgical procedures and responding to topical steroids.

Patch-testing with allergens on the NACDG tray, lidocaine dilutions, and suture materials showed positive reactions to lidocaine 15% (++), 10% (+), 5% (+) and 1% (+); also, reactions to neomycin 20%, bacitracin 20%, cobalt 1%, and gold 0.5% were positive. Pertinent negative reactions to the amides dibucaine 2.5% and prilocaine 2.5% and to the esters benzocaine 5% and tetracaine 1% were observed. Intradermal test results with lidocaine 1%, mepivacaine 2%, and bupivacaine 0.5% were positive for lidocaine and mepivacaine. The positive lidocaine intradermal test reaction was not vesicobullous as was noted in the postoperative clinical reaction. The patient had a negative skin-prick test reaction to latex and lidocaine. We recommended the use of bupivacaine for future interventions that require a local anesthetic.

Case 2 (Patient 10)

A 51-year-old woman presented for patch testing prior to orthopedic surgery. She reported past relevant delayed hypersensitivity reactions to injectable lidocaine administered intraarticularly, with localized and some disseminated rash and swelling. The patient also had a history of metal allergy to gold and cobalt. Patch tests with the NACDG tray and the Cleveland Clinic prosthesis tray revealed positive reactions to lidocaine 15% (+), nickel 2.5%, and palladium 2%. Patch tests with dibucaine 2.5% and benzocaine 5% gave negative results. Intradermal testing was not performed. The patient was instructed to avoid lidocaine in future procedures.

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