Atopic disease and/or atopy are risk factors for local anesthetic allergy in patients with history of hypersensitivity reactions to drugs?

Background and Objective: There is some concern among physicians that a positive history of adverse reactions to drugs and/or atopic disease remains a risk factor for developing a hypersensitivity reaction to local anesthetics (LA). In the present study we aimed allergy testing to LA is justified in patients with a positive history of hypersensitivity reactions to drugs additionally by atopy and atopic diseases. Patients and Methods: A standard questionnaire regarding demographic data, history of atopic disease (asthma, allergic rhinitis, atopic dermatitis, urticaria) was filled out, total IgE and eosinophil count were assesed for each patient. Skin prick tests (SPT), intradermal test (IDT) and subcutaneus incremental challenge test (ICT) were perfomed step by step with adrenaline free aritmal (lidokain HCL 2%, Osel) and citanest (prilokain HCL 2%, Astra Zeneca). Results: 239 patients with history of drug allergy were admitted. When we look at the results of skin tests and provocations with LA; while positive results of SPT werent found, 3 of IDT and 4 of ICT were positive. Of the all 4 patients that reacted to LA, had rhinosinusitis and a positive SPT reaction with aeroallergens, 1 had also food allergy, 2 had asthma. Conclusion: There is no increased risk requiring performing skin and provocation test for LA in the patients with a history of hypersensitivity reaction to drugs alone but additionally by presence of atopy, atopic disease and multidrug allergy history can increase the risk of LA allergy, the amount of evidence is scarce.