2508. Package #625 (Allergy screening for anesthetics: Articain, Lidocain)

Anesthetic allergy is an immune system reaction to drugs used for pain relief or numbness. Anesthetics can be administered locally (applied to a specific area of the body or injected under the skin) or systemically (injected into the bloodstream).

There are two main types of allergic reactions to anesthetics:

• immediate (Type I) reactions occur within minutes of anesthetic administration and are caused by immunoglobulin E (IgE), released by the immune system in response to an allergen;
• delayed (Type IV) reactions occur several hours or days after anesthetic administration.

Elevated IgE levels to articaine or lidocaine indicate possible sensitization to these drugs, increasing the risk of an allergic reaction with subsequent administration. This test helps prevent dangerous allergic reactions during surgery or dental procedures and reduces the risk of life-threatening reactions such as anaphylaxis, allowing the selection of a safer alternative anesthetic.

Allergic reactions to local anaesthetics are uncommon (true IgE-mediated responses are rare), yet may present across a wide spectrum – from localised pruritus and urticaria to bronchospasm, angioedema, and anaphylaxis. The majority of adverse effects following anaesthesia are attributable not to immune mechanisms but to toxic effects, overdose, or excipients (epinephrine, sulphites, parabens, etc.), which may clinically mimic allergy.

Articaine is the most widely used amide local anaesthetic in dentistry; reactions range from localised dermatological manifestations at the injection site to systemic symptoms.

Lidocaine is used for local and regional anaesthesia and as an antiarrhythmic agent; in addition to injectable forms, it is available as sprays, gels, and drops, making both contact and systemic reactions possible.

It is important to be aware of latex-associated reactions (gloves, elastic components of equipment), which are sometimes erroneously attributed to anaesthetic allergy.

Laboratory determination of specific IgE antibodies to articaine and lidocaine helps differentiate true allergy from pseudoallergy and toxicity, identify the causative factor, and reduce the risk of adverse events during future procedures. Results should be interpreted comprehensively – taking into account the patient's history, clinical presentation of the episode, concomitant medications, and potential co-triggers (preservatives, adrenaline, latex).

Testing for specific IgE antibodies to articaine and lidocaine is prescribed:

• in cases of a history of allergic reactions following local anesthesia (e.g., at the dentist's office or during local anesthesia for surgical procedures);
• in the presence of symptoms such as pruritus, urticaria, angioedema, dyspnea, or even anaphylaxis following the administration of an anesthetic;
• for differential diagnosis to distinguish true allergy from pseudoallergy or a toxic reaction;
• prior to planning the repeated use of articaine or lidocaine.

• Venous blood

In order to exclude factors that may affect the test results, we recommend to follow the preparation rules: