Allergies to Amide LA's....

[soonerfrog]

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I've seen it posted here on a couple of occasions. I think we all agree that amide "allergies" are most often: ****** dentists mistaking sympathetic reactions to epi in local, sensitivity to preservatives in the local, ie PABA, ect or just simply folks confusing and subsequently transposing "side effect" profiles with a genuine IgE mediated antigen-antibody reaction. Ester LA's enjoy a long history of true allergic reactions. What are folks thoughts about genuine amide LA allergies?

 

[Precedex]

I think we all agree that amide "allergies" are most often: ****** dentists mistaking sympathetic reactions to epi in local, sensitivity to preservatives in the local, ie PABA, ect or just simply folks confusing and subsequently transposing "side effect" profiles with a genuine IgE mediated antigen-antibody reaction.

No.
Nice to be supportive of the dental profession.
I hope you floss.

 

[soonerfrog]

The "jab" at dentists was more satirical than it was genuine condemnation. It was borne from some measure of frustration over the years after having pt after pt explain they are "allergic" to medication they clearly are not. If I have offended you or your dental colleagues, please except this apology and we can refocus the discussion to the legitimate academic principle originally enlisted. 😉

 

[Gaseous Clay]

Seems the esteemed OP has it all figured out, not sure the point of this thread.

 

[IlDestriero]

It's not usually hard to determine what was a normal reaction to epi and what was some other kind of reaction. For the most part, if the patient says that they're allergic to something, I don't give it to them. If their mother had a reaction to vanco and they say that they're allergic because of that, we talk about why they are not and do the right thing.

 

[chmd]

My favorite allergy so far has been a patient who explained to me she was allergic to LR because her psychiatrist said it made her anxious.

 

[deleted171991]

My favorite is from last week. Patient presents with lidocaine allergy that manifested at the dentist by difficulty swallowing, significant shortness of breath resulting in call to 911 and (this is the precious part) droopy face on the side of the injection. Of course, the shaman of dental science told her that she was allergic to lidocaine, not that he injected too deeply.

 

[jwk]

I've seen it posted here on a couple of occasions. I think we all agree that amide "allergies" are most often: ****** dentists mistaking sympathetic reactions to epi in local, sensitivity to preservatives in the local, ie PABA, ect or just simply folks confusing and subsequently transposing "side effect" profiles with a genuine IgE mediated antigen-antibody reaction. Ester LA's enjoy a long history of true allergic reactions. What are folks thoughts about genuine amide LA allergies?

According to one of my mentors who did some of the original work on lidocaine many decades ago, his thought was that true lidocaine allergies are so rare that they are reportable. It's remotely possible - but far from probable.

 

[twoliter]

I've seen it posted here on a couple of occasions. I think we all agree that amide "allergies" are most often: ****** dentists mistaking sympathetic reactions to epi in local, sensitivity to preservatives in the local, ie PABA, ect or just simply folks confusing and subsequently transposing "side effect" profiles with a genuine IgE mediated antigen-antibody reaction. Ester LA's enjoy a long history of true allergic reactions. What are folks thoughts about genuine amide LA allergies?

My thought is that I'd rather have a patient with a reported allergy to lidocaine, whether real or not as it's a pretty easily avoidable drug with minimal downside of not giving it, than a patient with allergies to fentanyl, morphine, Dilaudid, Versed, propofol, benadryl, and hydrocortisone.

 

[Twptophan]

Retrobulbar block --> brain stem anesthesia --> pt allergic to local anesthetics.

 

[Planktonmd]

According to one of my mentors who did some of the original work on lidocaine many decades ago, his thought was that true lidocaine allergies are so rare that they are reportable. It's remotely possible - but far from probable.

Correct!