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Recurrent facial swelling following dental procedures

Louise A Evans, Judy Pointing, Edward J Wills, Stephen Adelstein and John Michalopoulos
Med J Aust 2002; 177 (9): 522. || doi: 10.5694/j.1326-5377.2002.tb04928.x
Published online: 4 November 2002
Discussion

Local anaesthetics can be classified into ester-type agents (eg, procaine, benzocaine) and amide-type agents (eg, lignocaine, bupivacaine, mepivacaine). Although allergic reactions to local anaesthetic agents are uncommon, both type 1 reactions (via an IgE-mediated mechanism) and delayed-type hypersensitivity (DTH) reactions have been described.1-5

This patient demonstrated a DTH reaction to two agents from the amide class of anaesthetics. Presumably, sensitisation to lignocaine had occurred at the time of previous procedures using the agent. Cross-reactivity with another amide-type local anaesthetic is the most likely explanation for the less intense reaction seen with citanest. Although DTH reactions to local anaesthetics are rare, this case highlights the fact that DTH reactions should be considered in the differential diagnosis of local reactions after procedures using local anaesthesia. This may avoid unnecessary investigations, misdiagnoses and inappropriate treatment.

  • Louise A Evans1
  • Judy Pointing2
  • Edward J Wills3
  • Stephen Adelstein4
  • John Michalopoulos5

  • 1 Royal Prince Alfred Hospital, Camperdown, NSW.
  • 2 Grosvenor Place Dental Centre, Sydney, NSW.



  • 1. Fisher MM, Bowey CJ. Alleged allergy to local anaesthetics. Anaesth Intensive Care 1997; 25: 611-614.
  • 2. Astarita C, Gargano D, Romano C, et al. Long term absence of sensitization to mepivacaine as assessed by a diagnostic protocol including patch test. Clin Exp Allergy 2001; 31: 1762-1770.
  • 3. Curley RK, Macfarlane AW, King CM. Contact sensitivity to the amide anaesthetics lidocaine, prilocaine and mepivacaine. Arch Dermatol 1986; 122: 924-926.
  • 4. Klein CE, Gall H. Type IV allergy to amide-type local anesthetics. Contact Dermatitis 1991; 25: 45-48.
  • 5. Bircher AJ, Messmer SL, Surber C, Rufli T. Delayed-type hypersensitivity to subcutaneous lidocaine with tolerance to articaine: confirmation by in vivo and in vitro tests. Contact Dermatitis 1996; 34: 387-389.

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