Provocative challenge with local anesthetics in patients with a prior history of reaction

Michael J. Chandler, Leslie C. Grammer, Roy Patterson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Possible allergic sensitivity to local anesthetic agents remains problematic for some patients who could benefit from their use. We retrospectively reviewed all our consultations for evaluation of local anesthetic allergy from 1965 to 1985 to assess the safety and efficacy of skin testing and provocative test dosing with a variety of local anesthetic agents. Fifty-nine patients reported 70 reactions from the administration of six different local anesthetics. Fifty-four patients could name one or more local anesthetic agents they believed were responsible, and five patients named only "caine" drugs. Multiple reactions of the same type to the same agent were considered as one reaction. On the basis of their history of reaction, the patients were categorized as follows: anaphylactoid reactions (urticaria, angioedema, wheezing, or hypotension within 1 to 2 hours of exposure), possible anaphylactoid reactions (tachycardia, dizziness, syncope, breathlessness, or pruritus occurring within 1 to 2 hours of exposure), contact dermatitis (a typical eczematous skin eruption after appropriate cutaneous sensitization), and other reactions (nonanaphylactoid reactions other than those already described or those occurring more than 2 hours after exposure). Fifty-nine patients were administered local anesthetics after skin testing and provocative test dosing, including two patients who required intravenous lidocaine (Xylocaine; Astra Pharmaceutical Products, Inc., Westboro, Mass.) acutely to control cardiac arrhythmias. These two patients had reported anaphylactoid reactions to oral antiarrhythmic drugs of the local anesthetic class. Despite the history of previous reactions, there were no positive skin tests or positive provocative drug challenges in any patients. We conclude that local anesthetics can be safely and effectively used despite the history of previous reactions if skin tests are negative and if incremental challenge is used. Patients reporting immediate reactions to oral and parenteral antiarrhythmic local anesthetics may be skin tested and cautiously challenged with these drugs. A protocol for performing these tests is suggested.

Original languageEnglish (US)
Pages (from-to)883-886
Number of pages4
JournalThe Journal of allergy and clinical immunology
Issue number6
StatePublished - Jun 1987

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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