Alergia a los anestésicos locales/Local anesthetics alergy

http://www.smo.edu.mx/jornada2013/








Hipersensibilidad a los anestésicos locales. Seis hechos y 7 mitos


HYPERSENSITIVITY TO LOCAL ANAESTHETICS- 6 FACTS AND 7 MYTHS
Joanna Lukawska, MRCP, M Rosario Caballero, PhD,Sophia Tsabouri, MD, PhD, Pierre Dugué, FRCP, MD, APH
Drug Allergy Clinic, Guy's & St
Current Allergy & Clinical Immunology, August 2009 Vol 22, No. 3
ABSTRACT
Local anaesthetics (LAs) are commonly used drugs. In spite of their widespread use, true hypersensitivity appears to be very infrequent. In fact most of the adverse reactions are due to pharmacological, toxic or vasovagal effects of LAs. Our review of the literature has shown that true allergy to LA is in fact exceptional. Skin tests for LA allergy, including skin-prick tests (SPT) and intradermal (ID) tests, have poor sensitivity and specificity. True LA allergy, when appropriate, has to be confirmed by challenge. Provocation challenge is safe and well tolerated.
http://www.allergysa.org/journals/2009/august/hypersensitivity-to-local-anaesthetics.pdf


Pruebas intradérmicas en pacientes con reacciones alérgicas putativas a los anestésicos locales. Análisis de 611 casos

INTRADERMAL TESTING ON PATIENTS WITH PUTATIVE ALLERGIC REACTIONS TO LOCAL ANAESTHETICS - ANALYSIS OF 611 CASES
Petrus J Germishuys, BChD, MSc, MDent
School of Dentistry, Faculty of Health Sciences,
University of Pretoria, Pretoria
Current Allergy & Clinical Immunology, March 2004 Vol 17, No. 1
SUMMARY
Background. Although allergic reactions to local anaesthetics (LAs) of the amide type are relatively rare, many patients and practitioners label any adverse reaction after administration of an LA as 'allergic'. Objective. The aim of this study was to evaluate the reliability of intradermal testing (IDT) of patients with a history of adverse reactions to LA, and to rule out a possible allergy so an alternative LA, unlikely to cause any reaction, could be selected. Methods. IDT was done on 611 patients referred to the author for assessment of LA allergy. Results. Positive skin reactions were found in 15 patients (2.5%). All responded favourably when a different amide LA was prescribed. Conclusion. These results indicate that IDT is safe and can be used to identify an LA that patients with a prior history of adverse reactions can tolerate.
http://www.allergysa.org/journals/march2004/intradermal%20testing.pdf



Reactividad cruzada entre anestésicos locales de tipo amida en un caso de alergia a mepivacaína

Cross-Reactivity Among Amide-Type Local Anesthetics in a Case of Allergy to Mepivacaine
P González-Delgado,1 R Antón,2 V Soriano,1 P Zapater,3 E Niveiro1
J Investig Allergol Clin Immunol 2006; Vol. 16(5): 311-313
Abstract.
Among the various adverse reactions to local anesthetics, IgE-mediated reactions, particularly to the more commonly used amide group, are extremely rare. We report the case of a 39-year-old man who suffered itching and generalized urticaria with facial angioedema 15 minutes after administration of mepivacaine. Skin tests revealed a strong positive reaction to mepivacaine, lidocaine, and ropivacaine, but negative reactions to bupivacaine and levobupivacaine. Furthermore, double-blind placebo-controlled subcutaneous challenge with bupivacaine and levobupivacaine was well tolerated. We conclude that an extensive allergologic study must be carried out in rare cases of true allergic reaction to amide-type local anesthetics in order to rule out cross reactivity.
Key words: Local anesthetics. Amide group. Allergy. Mepivacaine. Lidocaine. Ropivacaine. Bupivacaine. Levobupivacaine.
http://www.jiaci.org/issues/vol16issue05/8.pdf


Anafilaxia secundaria a levobupivacaina

Anaphylaxis secondary to levobupivacaine
Gupta,1 M. Fennelly,2 V. Ramesh3 and K. Agyare
Anaesthesia, 2011, 66, pages 942-944 doi:10.1111/j.1365-2044.2011.06815.x
Summary
We describe the case of a 25-year-old woman presented for elective lumbar decompression and microdiscectomy who, towards the end of her surgery, developed clinical signs of anaphylaxis. Skin testing later confirmed sensitisation to levobupivacaine and possibly MediShield, an anti-adhesion gel used following microdiscectomy. This case is the first confirmed case report of anaphylaxis in response to levobupivacaine. It also highlights the possibility that multiple agents may simultaneously trigger a life-threatening reaction. Anaesthetists should remain alert to the use of potentially allergenic agents employed by surgeons.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.06815.x/pdf



Alergia a ropivacaína peridural

Whizar-Lugo VM, Ontiveros-Morales P, Garfias-Flores ME.
Anest Mex 2004;16:180-183.
Resumen
Las reacciones alérgicas a los anestésicos locales del grupo amino amida son muy raras, y no hay casos reportados de alergias secundarios a la ropivacaína peridural. Informamos un paciente mexicano, de 62 años de edad, diabético con dolor torácico intenso secundario a herpes Zoster agudo, al cual se le realizó un bloqueo peridural con 6 mL de ropivacaína simple al 0.25% y 20 minutos después desarrolló una dermatosis pruriginosa localizada en el cuello y el tórax. Esta reacción se repitió con la segunda inyección peridural de 6 mL de ropivacaína simple al 0.125%, por lo que las subsecuentes inyecciones peridurales se hicieron con bupivacaína racémica 0.125%, sin efectos secundarios. El paciente fue seguido durante un año y no tuvo secuelas neurológicas, ni desarrolló neuropatía postherpética. Se ha dicho que los nuevos anestésicos locales levoisoméricos no inducen reacciones alérgicas. Este paciente demuestra que debemos
de estar alertas ante esta remota posibilidad.
Palabras clave: Alergias, anestésicos locales, ropivacaína epidural.
http://www.anestesiaenmexico.org/RAM3/011.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org