Adverse reaction to local anaesthetics: is it always allergy?

Local anaesthetics (LA) are commonly used into daily clinical practice for many operational procedures (in both primary care and dentistry and across all hospital specializations). The literature reports few and controversial data on the prevalence of IgE-mediated allergic reactions to LA, as adverse reactions are common and may simulate a hypersensitivity reaction. The real incidence of allergic reactions to LAs is reported to be < 1% (Berkun et al., 2003, Gall et al., 1996, Giovannitti & Bennett, 1979). The major adverse drug reactions to LA, which often have a non-allergic mechanism, do include: toxic reactions, such as paraesthesia and dizziness caused by overdose; vasovagal reactions, such as hypotension and sinus bradycardia; anxiety responses; hyperventilation syndrome; reactions caused by concomitant adrenaline administration (tachycardia, palpitations, hyperventilation) (Adriani, 1972, Berkun et al., 2003). This article is protected by copyright. All rights reserved.