scholarly journals Immediate local anesthetic reactions and diagnostic test results in pediatric patients

2021 ◽  
Vol 49 (3) ◽  
pp. 108-114
Author(s):  
Ahmet Selmanoglu ◽  
Hakan Guvenir ◽  
İlknur Kulhas Celik ◽  
Betul Karaatmaca ◽  
Muge Toyran ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Local Anesthetics ◽  
Pediatric Patients ◽  
Diagnostic Testing ◽  
Challenge Test ◽  
Skin Tests ◽  
Test Results ◽  
Life Threatening ◽  
History Of ◽  
Ige Mediated

Background/objectives: Adverse reactions to local anesthetics are relatively common, but proven IgE-mediated allergy is extremely rare. We aimed to determine the frequency of local anesthetic allergy in pediatric patients.Patients and methods: The medical records of 73 patients who presented to our clinic with a history of suspected allergic reaction to local anesthetics and underwent diagnostic testing between 2012 and 2020 were retrospectively analyzed. Diagnoses were based on case histories, skin tests, and subcutaneous challenge tests.Results: A total of 75 test series were carried out on the 73 patients (43 boys; median [IQR] age 9.25 [7.26–14.25] years, range 3–17.8 years). The most commonly tested drugs were lido-caine (n = 38; 50.6%) and prilocaine (n = 15; 20%). Local anesthetic allergy was confirmed in one (1.3%) of the 73 patients by positive subcutaneous challenge test with mepivacaine. Conclusion: There are limited data in the current literature regarding local anesthetic allergies and diagnosis test results in pediatric patients. Proven local anesthetic allergy is less common than expected by society and physicians, and therefore diagnostic tests are needed for patients with no contra-indications such as severe or life-threatening reactions.

scholarly journals Lidocaine: A Local Anesthetic, Its Adverse Effects and Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 782
Author(s):  
Entaz Bahar ◽  
Hyonok Yoon
Keyword(s):  
Adverse Effects ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Adverse Reactions ◽  
Rapid Diagnosis ◽  
Diagnosis And Treatment ◽  
Allergic Reactions ◽  
Life Threatening

The most widely used medications in dentistry are local anesthetics (LA), especially lidocaine, and the number of recorded adverse allergic responses, particularly of hazardous responses, is quite low. However, allergic reactions can range from moderate to life-threatening, requiring rapid diagnosis and treatment. This article serves as a review to provide information on LA, their adverse reactions, causes, and management.

scholarly journals Anaphylaxis to patent blue dye in a 17-year-old boy

2019 ◽  
Vol 12 (1) ◽  
pp. e226191 ◽  
Author(s):  
Mélanie Leung ◽  
Christine McCusker ◽  
Moshe Ben-Shoshan
Keyword(s):  
Food Additive ◽  
Skin Tests ◽  
Blue Dye ◽  
Patent Blue ◽  
Paediatric Case ◽  
Biphasic Reaction ◽  
Life Threatening ◽  
Ige Mediated ◽  
Patent Blue V ◽  
Patent Blue Dye

Patent blue V dye (PBV) is frequently used as a perioperative drug for lymphangiography, as well as a food additive. Hypersensitivity to PBV is poorly documented in adults and had not been previously described in children. The diagnosis of PBV allergy depends on corroboration of history consistent with an IgE-mediated reaction and confirmatory skin tests. We present in this paper a paediatric case of PBV anaphylaxis and of biphasic reaction that exemplifies the challenges involved in diagnosing and managing this rare but potentially life-threatening allergic reaction.

Development of Meningitis During Therapy with Cefamandole

PEDIATRICS ◽  
1981 ◽  
Vol 67 (5) ◽  
pp. 727-728
Author(s):  
S. C. Aronoff ◽  
W. Thomford ◽  
J. S. Bertino ◽  
W. T. Speck
Keyword(s):  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Pediatric Patients ◽  
Potential Hazard ◽  
Procaine Penicillin ◽  
Source Of Infection ◽  
Local Physician ◽  
Life Threatening ◽  
History Of

Cefamandole nafate is a relatively new cephalosporin approved for use in pediatric patients. This compound offers certain advantages over previously approved cephalosporins including its in vitro antimicrobial activity against β-lactamase-producing Haemophilus influenzae. The purpose of this report is to describe a potential hazard associated with the use of this and closely related antimicrobial agents in life-threatening bacterial infections. CASE REPORT This was the first Rainbow Babies and Childrens Hospital admission for this 7-month-old boy with a ten-day history of fever and irritability. Seven days prior to admission he was seen by a local physician for fever. No source of infection was noted and the infant was treated with 300,000 units of intramuscular procaine penicillin.

scholarly journals Local Anesthetics: Review of Pharmacological Considerations

2012 ◽  
Vol 59 (2) ◽  
pp. 90-102 ◽  
Author(s):  
Daniel E Becker ◽  
Kenneth L Reed
Keyword(s):  
Adverse Effects ◽  
Continuing Education ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Dental Practice ◽  
Efficacy And Safety ◽  
History Of ◽  
Technical Considerations

Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. Their use is so routine, and adverse effects are so infrequent, that providers may understandably overlook many of their pharmacotherapeutic principles. The purpose of this continuing education article is to provide a review and update of essential pharmacology for the various local anesthetic formulations in current use. Technical considerations will be addressed in a subsequent article.

scholarly journals Aliphatic Halogenated Hydrocarbons: Report and Analysis of Liver Injury in 60 Patients

2018 ◽  
Author(s):  
Rolf Teschke
Keyword(s):  
Liver Injury ◽  
Halogenated Hydrocarbons ◽  
Study Cohort ◽  
Test Results ◽  
Cell Necrosis ◽  
Late Initiation ◽  
Toxin Removal ◽  
Life Threatening ◽  
History Of ◽  
New Treatment

Background and Aims: Intoxications by aliphatic halogenated hydrocarbons (AHH), used as effective solvents, are rare and may cause life-threatening liver injury. Patients with acute intoxications by AHH received an innovative treatment. Methods: Analyzed were data of 60 patients intoxicated by AHH, such as dichloromethane (n = 3), chloroform (n = 2), carbon tetrachloride (n = 12), 1,2-dichloroethane (n = 18), 1,1,2-trichloroethane (n = 2), trichloroethylene (n = 2), tetrachloroethylene (n = 13) or mixed AHH chemicals (n = 8), who received a new treatment consisting of CO2-induced hyperventilation to accelerate toxin removal via the lungs. Results: Added to the inspiration air at a flow rate of 2–3 Liter min−1, CO2 increased the respiratory volume up to 25–30 Liter min−1, ensuring forced AHH exhalation. This CO2-induced hyperventilation therapy was commonly well tolerated by the 60 patients and lasted for 106.0±10.5 hours. In most cases, initially increased liver test results of aminotransferases normalized quickly under the therapy, and liver histology obtained at completion of the therapy revealed, in the majority of patients, normal findings or fatty changes, and rarely severe single cell necrosis but no confluent liver cell necrosis. Despite therapy, clinical outcome was unfavorable for 4/60 patients (6.7%) of the study cohort, due to single or combined risk factors. These included late initiation of the CO2-induced hyperventilation therapy, intentional intoxication, uptake of high amounts of AHH, concomitant ingestion of overdosed drugs, consumption of high amounts of alcohol, and history of alcohol abuse. Conclusions: For intoxications by AHH, effective therapy approaches including forced hyperventilation to increase toxin removal via the lungs are available and require prompt initiation.

Diagnostic value and safety of penicillin skin tests in children with immediate penicillin allergy

2020 ◽  
Vol 41 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Ilknur Kulhas Celik ◽  
Irem Turgay Yagmur ◽  
Ozge Yilmaz Topal ◽  
Muge Toyran ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Diagnostic Value ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Provocation Tests ◽  
Test Kit ◽  
History Of ◽  
Drug Provocation Tests ◽  
Immediate Reactions

Background: The first-line method in the diagnosis of patients who describe an immediate reaction after penicillin intake is a skin test (ST) with penicillin reagents. Objectives: We aimed to determine the safety and diagnostic value of penicillin STs in the diagnosis of immediate reactions to penicillins in pediatric patients. Methods: The study included pediatric patients with suspected immediate reaction to penicillin who were subjected to STs by using a standard penicillin test kit as well as suspected penicillin and the drug provocation tests (DPT) with the suspected penicillin at our clinic. Results: A total of 191 patients (53.9% boys) with a median age of 6.83 years (interquartile range, 4.2‐12 years) were included in the study. The time from drug intake to the onset of reaction was ≤1 hour in 138 patients (72.3%) and 1 to 6 hours in 53 patients (27.7%). Penicillin allergy (PA) was confirmed by diagnostic tests in 36 of the 191 patients (18.8%). In multivariate logistic regression analysis, the history of both urticaria and angioedema (odds ratio [OR] 27.683 [95% confidence interval {CI}, 3.143‐243.837]; p = 0.003) and anaphylaxis (OR 56.246 [95% CI, 6.598‐479.489]; p < 0.001) were the main predictors of a PA diagnosis. Although ST results were positive in 23 patients (63.8%), 13 patients (26.2%) had positive DPT results despite negative ST results. The negative predictive value (NPV) of STs was calculated 92.2% (155/168). None of our patients experienced immediate or delayed systemic and/or local reactions in relation to the STs. Conclusion: A history of urticaria with angioedema and anaphylaxis were the main predictors of true PA in children with suspected immediate reactions. STs with penicillin reagents are safe for use in children. Although STs have a high NPV, DPT is the gold standard for diagnosis. DPTs should be performed as the final step of the diagnostic evaluation of PA in patients with negative ST results.

scholarly journals Antihistamines in Clinical Dentistry offering a Choice for Second Possibility in Reported Cases of Allergy to Local Anesthetics: Report of Two Cases and Literature Review

2014 ◽  
Vol 5 (1) ◽  
pp. 35-38
Author(s):  
Shahanavaj Imam Husen Khaji
Keyword(s):  
Literature Review ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Drug Allergy ◽  
Dental Treatment ◽  
Present Report ◽  
Chemical Structures ◽  
Anesthetic Agents ◽  
History Of ◽  
Treatment Procedures

ABSTRACT Drug allergy encompasses a spectrum of immunologically mediated hypersensitivity reaction with varying mechanisms and clinical presentation. Type of adverse drug reaction not only affects patient's quality of life, but may also lead to delayed treatment, unnecessary investigations and even mortality. The most effective strategy for the management of drug allergy is the avoidance or discontinuation of the offending drug. When available, alternative medications with unrelated chemical structures should be substituted. Patients who presents with history of allergy to local anesthetics are common in dental practices. In the present report, retrospective documented history of allergy to local anesthetics (lidocaine) in two patients (50 years/female, 35 years/male) were evaluated critically and needful dental treatment procedures were carried out using antihistamines pheniramine maleate: 22.75 mg/ml; DPH HCl: 1%) as local anesthetic agents. In both the cases, antihistamines proved to be beneficial, effective, devoid of complications. In conclusion, use of antihistaminic drugs in patients with documented history of allergy could be an alternative drug of choice having local anesthetic properties for minor dental treatment procedures in routine dental practice. How to cite this article Khaji SIH. Antihistamines in Clinical Dentistry offering a Choice for Second Possibility in Reported Cases of Allergy to Local Anesthetics: Report of Two Cases and Literature Review. Int J Head Neck Surg 2014;5(1):35-38.

ASSESSMENT OF PATIENTS WHO HAVE EXPERIENCED ANAPHYLAXIS: A 3-YEAR SURVEY

PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 384-384
Author(s):  
Hugh A. Sampson
Keyword(s):  
Emergency Treatment ◽  
Immunoglobulin E ◽  
Positive Test ◽  
Skin Tests ◽  
Test Results ◽  
Detailed History ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin ◽  
History Of

The authors concluded that a minimal workup for anaphylaxis should include elicitation of a detailed history of allergic episodes, performance of prick skin tests or quantification of allergen-specific immunoglobulin E(IgE), further exploration of any positive test results, and regular follow-up of all patients to gauge the success of avoidance and emergency treatment.

scholarly journals Modified Oral Metronidazole Desensitization Protocol

2014 ◽  
Vol 5 (2) ◽  
pp. ar.2014.5.0080 ◽  
Author(s):  
Samantha R. Gendelman ◽  
Lily C. Pien ◽  
Ravi C. Gutta ◽  
Susan R. Abouhassan
Keyword(s):  
Nasal Congestion ◽  
Skin Tests ◽  
Positive Skin ◽  
Intradermal Testing ◽  
History Of ◽  
Desensitization Protocol ◽  
Ige Mediated ◽  
Systemic Symptoms ◽  
Oral Metronidazole ◽  
Oral Desensitization

The Center for Disease Control guidelines recommend desensitization to metronidazole in patients with trichomoniasis and hypersensitivity to metronidazole. There is only one published oral metronidazole desensitization protocol. The purpose of this study was to design a new, more gradual oral desensitization protocol to decrease systemic reactions that may occur when using the previously published protocol. We present two patients with presumed IgE-mediated allergy to metronidazole who underwent oral desensitization using our modified protocol. Case 1 was a 65-year-old woman with trichomoniasis who presented for metronidazole desensitization with a history of intraoperative anaphylaxis and positive skin tests to metronidazole. The patient tolerated six doses of the modified desensitization but developed systemic symptoms of nasal congestion and diffuse pruritus after the 25- and 100-mg doses. Both reactions were treated with intravenous (i.v.) antihistamines. Because of gastrointestinal irritation, the desensitization was completed at a dose of 250 mg orally every 6 hours. Case 2 was a 42-year-old woman with trichomoniasis and a history of hives immediately after administration of i.v. metronidazole who presented for desensitization. The patient had negative skin-prick and intradermal testing to metronidazole. She developed lip tingling and pruritus on her arms 15 minutes after the 10-mg dose. Fexofenadine at 180 mg was given orally and symptoms resolved. She tolerated the rest of the protocol without reaction and received a total dose of 2 g of metronidazole. Our oral metronidazole desensitization for presumed IgE-mediated reactions offers a second option for physicians wishing to use a more gradual escalation in dose.

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