RESUMO
BACKGROUND: Adverse reactions to local anesthetics (LAs), especially esters, are not uncommon, but true allergy is rarely diagnosed. To our knowledge, currently there is no reliable method of determining IgE-mediated hypersensitivity to LAs and cocaine. OBJECTIVE: To assess the clinical value of allergy tests (prick, IgE, challenges, and arrays) in people suffering hypersensitivity reactions (asthma and anaphylaxis) during local anesthesia with cocaine derivatives and drug abusers with allergic symptoms after cocaine inhalation. METHODS: We selected cocaine-dependent patients and allergic patients who suffered severe reactions during local anesthesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity, and predictive value) of allergy tests using cocaine and coca leaf extracts in determining cocaine allergy was assessed, taking a positive challenge as the criterion standard. RESULTS: After prick tests, specific IgE, and challenge with cocaine extract, 41 of 211 patients (19.4%) were diagnosed as sensitized to cocaine. Prick tests and IgE to coca leaves (coca tea) had a good sensitivity (95.1% and 92.7%, respectively) and specificity (92.3 and 98.8%, respectively) for the diagnosis of cocaine allergy and LA-derived allergy. CONCLUSIONS: Cocaine may be an important allergen. Drug abusers and patients sensitized to local anesthesia and tobacco are at risk. Both prick tests and specific IgE against coca leaf extract detected sensitization to cocaine. The highest levels were related to severe clinical profiles.
Assuntos
Alérgenos/imunologia , Anestésicos Locais/imunologia , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Cocaína/imunologia , Hipersensibilidade a Drogas/diagnóstico , Adolescente , Adulto , Anestésicos Locais/uso terapêutico , Coca , Cocaína/análogos & derivados , Cocaína/uso terapêutico , Estudos Transversais , Feminino , Humanos , Imunização , Imunoglobulina E/metabolismo , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/imunologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Testes Cutâneos , Adulto JovemRESUMO
BACKGROUND: Topical medicaments are a common cause of allergic contact dermatitis. This study will evaluate the prevalence of contact allergy to a wide array of topical medicaments at the Ottawa Patch Test Clinic. OBJECTIVES: The objectives of this study are to report the results of positive patch testing to topical medicaments at the Ottawa Patch Test Clinic and identify common sensitizers in topical medicaments. METHODS: Patients were tested with the standard North American Contact Dermatitis screening series of 70 allergens plus supplementary allergens when indicated. A retrospective chart review of patients positive to topical medicaments between January 1, 2000, and September 30, 2010, was undertaken. RESULTS: The average age of patients was 49.5 years. Thirty-four percent were atopic. Common sensitizers included topical antibiotics (58%), steroids (30%), anesthetics (6%), and antifungals (6%). Patch testing showed that 61% of patients tested positive to antibiotics, 21% to topical steroids, 17% tested positive to topical anesthetics, and 1% tested positive to topical antifungals. The most common reactions were to bacitracin (44%) and neomycin (29%). The most common steroid screener was tixocortol-17-pivalate (group A) (19%), and the most common local anesthetic was lidocaine (12%). CONCLUSIONS: Topical medicaments of all kinds are common causes of allergic contact dermatitis. Those that are more readily available, in over-the-counter preparations, are the most frequent culprits.
Assuntos
Dermatite Alérgica de Contato/etiologia , Toxidermias/etiologia , Administração Tópica , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/imunologia , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Anestésicos Locais/imunologia , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/imunologia , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Antifúngicos/imunologia , Bacitracina/administração & dosagem , Bacitracina/efeitos adversos , Bacitracina/imunologia , Feminino , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/efeitos adversos , Hidrocortisona/análogos & derivados , Hidrocortisona/imunologia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Lidocaína/imunologia , Masculino , Pessoa de Meia-Idade , Neomicina/administração & dosagem , Neomicina/efeitos adversos , Neomicina/imunologia , Ontário , Testes do Emplastro , Estudos RetrospectivosRESUMO
OBJECTIVES: Although true allergic reactions to local anaesthetics are rare in the general population, the importance of the problem among asthmatic children has yet to be documented. SAMPLE AND METHODS: Skin prick, intradermal and incremental challenge tests with lidocain were performed in 157 asthmatic children aged 8-15 years and compared with 72 nonasthmatic children of a similar age. All of the asthmatic subjects were allergic to at least one allergen, most frequently pollens and house dust mites. Prick testing began with an undiluted solution in patients without a history of allergy and with 1:100 dilution in those with a reaction history. Following negative prick testing, intradermal or incremental challenge tests were performed. RESULTS: A total of 125 patients (80%) had been given local anaesthetics in the past, only three children gave history of an adverse local reaction. At the end of the tests, none of the subjects including controls, were found to have immediate or delayed-type allergy to lidocain. CONCLUSIONS: Local anaesthetic allergy does not seem to be a serious problem among asthmatic children and testing in all asthmatic children is not warranted. Those with an adverse reaction history to local anaesthetics should be tested with these drugs.
Assuntos
Anestésicos Locais/imunologia , Asma/imunologia , Hipersensibilidade a Drogas/imunologia , Lidocaína/imunologia , Adolescente , Alérgenos/imunologia , Animais , Criança , Feminino , Humanos , Hipersensibilidade Tardia/imunologia , Hipersensibilidade Imediata/imunologia , Hipersensibilidade ao Látex/imunologia , Masculino , Ácaros/imunologia , Pólen/imunologia , Rinite Alérgica Perene/imunologia , Rinite Alérgica Sazonal/imunologia , Testes CutâneosRESUMO
Lignocaine in very high doses exhibits immunodepressant properties in vitro. In vivo, in surgical patients submitted to spinal anaesthesia, lymphocyte transformation is diminished for one week. This inhibition is, however, less marked than after general anaesthesia.