Topical Gel Allergies??

[mwsung]

I recently extracted #16 under the strawberry flavored topical gel and 4% Articane.
after 30 min pt left, she called back saying she was having allergic reactions.
Pt was advised to go to ER since she knew Benadryl wouldn't work.
Her med hx indicates "strawberry" as an allergen.
pt returend to have a copy of her med hx and O.S consent form. Told me she had to have an IV at ER to get better. She then mentioned she is allergic to koolade, gums or anything that has strawberry related things in it. anything with strawberry artificial or natural...
She isn't currently having any problems. She told me she had no extraoral swelling or rashes but her throat felt swollen. Everything has been documented thoroughly.
I just don't know what her intention is to ask for those copies. Also, does the flavored topical benzocain really contains strawberry??

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[flapaTron]

I recently extracted #16 under the strawberry flavored topical gel and 4% Articane.
after 30 min pt left, she called back saying she was having allergic reactions.
Pt was advised to go to ER since she knew Benadryl wouldn't work.
Her med hx indicates "strawberry" as an allergen.
pt returend to have a copy of her med hx and O.S consent form. Told me she had to have an IV at ER to get better. She then mentioned she is allergic to koolade, gums or anything that has strawberry related things in it. anything with strawberry artificial or natural...
She isn't currently having any problems. She told me she had no extraoral swelling or rashes but her throat felt swollen. Everything has been documented thoroughly.
I just don't know what her intention is to ask for those copies. Also, does the flavored topical benzocain really contains strawberry??

this was in her chart before you used the topical?

 

[mwsung]

Yes it was. but i didn't think the topical gel has any REAL strawberry in it.. its contents say some chemicals, some colorings, and "flavor" under ingredients... other patients with same allergies were ok so I didn't take it too seriously... my bad... but really??

 

[flapaTron]

do you have any alternate flavors in your office? if so, it probably would have been better to use one of those....

whether or not the reaction was actually caused by your topical or something completely unrelated OR if the product actually contained any strawberry by products, from the patient's perspective, he or she may be thinking "dentist used strawberry goop in my mouth, and i'm allergic to strawberries = negligence = lawsuit".

 

[summers]

My 2 cents...
Benzocaine topical anaesthetics are ester derived versions of PABA which are well known allergic sensitising agents and are best avoided if possible (also in sunscreen and sulfur antibiotics - I think). In Australia we have xylocaine gel which is a good alternative.
I was doing a locum job and had a similar type reaction in the chair prior to procedure and had to give the patient IM Adrenaline and refer to the ED. No known Hx of allergies though.
In my case it was hard to tell if the topical anaesthetic is the culprit or the sensation of numbness in the throat and perhaps anxiety of the procedure.
So perhaps it may have been the anaesthetic itself, the numbing sensation in throat, the strawberry flavour or an anxiety reaction. As not many classic features were present: rash, SOB, neck/throat swelling etc.
A mast cell tryptase will tell if mast cells have degranulated - ie a true reaction but I dont think this can be done post adrenaline but may have been done by the ED prior to adrenaline.
Glad to hear pt is better and no long term harm done.
Luke

 

[ObviousGuy]

Exactly why I don't ever use topical. It's all mental anyway and the amount of anaphylactic reactions it was causing forced me to stop. Lawsuit after lawsuit.

 

[wantorthogpa2]

Why would you use strawberry if she has a history of anaphylaxis from it? doesnt make sense. I think she's probably going to sue. Next time, pay more attention to the MHx and use another flavor of topical. Sultan has a wide range and IIRC, pina colada was one of them. Pay attention next time.

 

[predentlove]

How much can she sue for?... JW