Identifying and Managing Local Anesthetic Allergy in Dermatologic Surgery

• Published in: Dermatologic surgery Vol. 42; no. 2; p. 147
• Main Authors: Fathi, Ramin, Serota, Marc, Brown, Mariah
• Format: Journal Article
• Language: English
• Published: United States 01.02.2016
• Subjects: Anesthetics, Local - adverse effects; Dermatologic Surgical Procedures; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - drug therapy; Drug Hypersensitivity - etiology; Drug Hypersensitivity - immunology; Epinephrine - therapeutic use; Histamine Antagonists - therapeutic use; Humans; Immunoglobulin E - immunology; Sympathomimetics - therapeutic use
• ISSN: 1524-4725
• DOI: 10.1097/DSS.0000000000000596

Local anesthetic (LA) allergy is a concern for dermatologic surgeons given the large number of procedures performed yearly with LAs. Many patients also have anxiety about past or potential anesthesia allergy. This article will review the symptoms of IgE-mediated allergic reactions, the prevalence of IgE-mediated LA allergy, discuss common mimics of LA, and propose a practical approach for diagnostic and therapeutic options for LA allergy for the dermatologic surgeon in practice. A literature search of Pubmed using keywords "lidocaine," "local anesthetic," "hypersensitivity," and "allergy" was performed. Amide anesthetics result in the most reports of true local anesthetic immediate hypersensitivity. True IgE-mediated anaphylaxis to local anesthesia is very rare. Dermatologic surgeons should be aware of the symptoms of anesthetic allergy and its mimickers, as well as how to manage allergic reactions in their clinical practice.