BackgroundLocal anesthetic (LA) drugs are commonly used in clinical practice to provide effective analgesia, including in dentistry and minor surgical procedures. The perception of a high risk of allergy in daily applications leads to the referral of atopic patients and those with other drug allergies to allergy clinics for the evaluation of allergic reactions to LA. The aim of this study was to determine who should be referred to the allergy clinic for LA allergy testing, assess the frequency of LA allergy in pediatric patients, and identify the negative predictive value of skin tests in diagnosis.MethodsJanuary 2017–July 2023, the clinical and laboratory data, as well as the results of drug allergy tests, of patients referred to our pediatric allergy clinic by dentists and physicians performing minor surgical procedures with suspected LA allergy were retrospectively evaluated.ResultsOur study included a total of 153 patients, comprising 84 girls (54.9%) and 69 boys (45.1%), with a mean age of 8.9 (±3.3) years. The most common reason for referral was a history of non‐LA drug allergies (n = 66, 43.2%), followed by asthma (n = 25, 16.3%). Hypersensitivity reactions (HRs) with LA were most commonly associated with articaine (n = 7, 4.8%), followed by lidocaine (n = 6, 4.1%). When intradermal tests were evaluated, 17 patients (11.1%) had a positive test result. The positivity for lidocaine was 70.6% (n = 12), and prilocaine was 29.4% (n = 5). Subcutaneous provocation was administered to 109 patients (71.2%), and one patient exhibited local erythema and swelling with prilocaine.ConclusionAlthough LA allergy is a rare occurrence, consultations of this nature are frequently requested from allergy clinics in real life. Considering the negative predictive value of skin tests performed with LA drugs, the reaction rate appears to be low in patients with atopy or other drug allergies. It is crucial for all relevant healthcare professionals to be knowledgeable about the appropriate approach to suspected LA allergies to avoid unnecessary tests. To the best of our knowledge, our study is the most comprehensive work in the literature that evaluates the results of diagnostic tests in children referred with a suspicion of LA allergy.

中文翻译：

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儿童局部麻醉药过敏：用真实数据评估诊断测试

背景局部麻醉 (LA) 药物在临床实践中常用来提供有效的镇痛，包括牙科和小型外科手术。由于人们认为日常应用中存在高过敏风险，因此将特应性患者和其他药物过敏患者转诊至过敏诊所，以评估对 LA 的过敏反应。本研究的目的是确定谁应该被转诊到过敏诊所进行 LA 过敏测试，评估儿科患者 LA 过敏的频率，并确定皮肤测试在诊断中的阴性预测价值。 方法 2017 年 1 月至 2023 年 7 月，对由牙医和医生转诊至我们的儿科过敏诊所进行小手术的疑似 LA 过敏患者的临床和实验室数据以及药物过敏测试结果进行了回顾性评估。结果我们的研究总共包括 153 名患者，其中 84 名患者为女孩 (54.9%) 和男孩 69 名 (45.1%)，平均年龄为 8.9 (±3.3) 岁。最常见的转诊原因是非 LA 药物过敏史（n= 66, 43.2%），其次是哮喘（n= 25, 16.3%）。LA 的过敏反应 (HR) 最常见与阿替卡因相关（n= 7, 4.8%)，然后是利多卡因 (n= 6, 4.1%）。在评估皮内测试时，17 名患者（11.1%）的测试结果呈阳性。利多卡因阳性率为 70.6%（n= 12），丙胺卡因为 29.4%（n= 5）。对109名患者（71.2%）进行了皮下激发，其中1名患者因丙胺卡因出现局部红斑和肿胀。结论虽然LA过敏很少发生，但现实生活中过敏诊所经常要求此类性质的咨询。考虑到使用 LA 药物进行的皮肤测试的阴性预测值，特应性或其他药物过敏患者的反应率似乎较低。对于所有相关的医疗保健专业人员来说，了解疑似洛杉矶过敏的适当方法以避免不必要的测试至关重要。据我们所知，我们的研究是文献中最全面的工作，评估了疑似洛杉矶过敏儿童的诊断测试结果。