Runny nose

How to test for allergies to epidural anesthesia. Allergy to anesthesia and after it: causes and what to do

An allergic reaction in response to the drug used for anesthesia occurs very quickly - instantly, within the first 10-15 minutes, after an hour and even after a day. The form of this reaction can be different, but the most severe is considered anaphylactic shock. All honey. institutions are equipped to provide successful first aid for this complication.

General principles for the development of drug allergies

Speaking about allergies to, it should be noted that as a result of its initial intake, sensitization is activated. Therefore, the ingested substance turns into. Repeated use is associated with the activation of mast cells, which direct histamine into the blood. The result is irritation of nerve endings, muscle and vascular spasms, mucus production and capillary dilation. Therefore, symptoms of allergies often include itching, rash, swelling and the anaphylaxis discussed above.

At the same time, there is also an immune-type reaction that manifests itself delayed. Leukocytes are sent to the area of inflammatory changes, and connective tissue is formed in place of the affected cells. The result is the development of complications in the form of dangerous pathologies. These include thrombocytopenia, hemolytic anemia, vasculitis, and serum sickness.

Features of allergies to anesthesia

Anesthesia is a special group of drugs that reduce the sensitivity of the body completely or its individual parts. Under their influence, nerve impulses stop passing, which is necessary for the operation. Anesthesia can be of two types:

General, when a person's sensitivity is completely eliminated as he is rendered unconscious. There are simple and combined anesthesia. It can be carried out by inhalation or by injecting the substance into a vein. This is a more difficult type of anesthesia for the patient, which requires preliminary preparation and examination.
Local– loss of sensation in an area of the body for a certain period of time. The conduction of individual nerves is switched off, but breathing and consciousness remain. The local type of anesthesia is easier to tolerate by patients, and there is no need for additional preparation. Typically used for operations of low complexity.

Local anesthesia can be:

terminal or superficial, when for pain relief the medicine is applied to the skin or mucous membrane from the outside;
infiltration – subcutaneous delivery of anesthetic;
regional with the drug entering areas close in location to the nerve trunk (conductor, spinal, epidural, intravascular, intraosseous anesthesia).

For general anesthesia, doctors can use Ftorotan, Methoxyflurane, Hexenal, Ketamine, Etomidate, and for local anesthesia - Benzocaine, Prilocaine. It is important to remember that an allergic reaction is provoked not only by the main active ingredient, but also by auxiliary elements. Allergies can be caused by adrenaline, stabilizers, preservatives or parabens.

the presence of previously occurring allergic manifestations as part of the medical history;
pathological deviations in the functioning of the endocrine system;
susceptibility to bronchial asthma or diabetes;
genetic predisposition;
frequent contacts with substances of a chemical nature.

If the drug is administered very quickly, used on an empty stomach, after severe illnesses, in combination with taking other medications, the likelihood of allergies will increase significantly.

Symptoms

The reaction to anesthesia varies in the speed of its manifestation - it can develop within 15 minutes, an hour after manipulation, or 12-24 hours. When the manifestation is observed instantly, doctors can quickly provide qualified assistance and reduce the risks of complications.

If the body’s response occurs after a day or a little less, then people do not always associate the symptoms with anesthesia, but try to concentrate on other reasons. This is fraught with improper self-medication, loss of time, which leads to negative consequences.

Allergy to general anesthesia in an adult or child has similar forms of manifestation:

development ;
active spread of edema in the larynx;
respiratory depression;
problems with the functioning of the heart, even to the point of cardiac arrest;
a sharp decrease in blood pressure.

If these signs appear, the condition should be assessed as quickly as possible and the patient should be provided with adequate medical care.

Local anesthesia can also provoke serious consequences up to anaphylactic shock. Such risks most often accompany anesthesia, although benzocaine also has reactions of this type. The most common manifestations are:

redness, soreness and swelling of tissues in the area of contact with the drug;
urticaria and the formation of blisters on the skin;
the formation of small red dots on the skin, which are localized in the area of the folds or joints;
itching sensation;
type and increased lacrimation;
epigastric pain;
nausea with vomiting;
diarrhea of varying intensity;
pain in the head with risk of loss of consciousness;
angioedema of angioedema nature.

To avoid death, resuscitation measures should be started on time!

It is also important to remember the fact that sometimes symptoms are not a consequence of the reaction to the drug itself, but are determined by the weakness of the body or non-compliance with the dosage. In particular, this is typical for intravenous general anesthesia, since its individual elements are toxic in nature and can adversely affect the functioning of the heart and respiratory system.

If the patient has heart disease, kidney disease, or chronic illnesses, then the use of anesthesia is fraught with many risks. In this case, it is recommended to give preference to local anesthesia with careful selection of the drug and dosage, as well as monitoring the condition by a specialist.

Danger of complications

In some cases, anesthesia for allergies can provoke a number of complications. In this case, it is very difficult to determine a change in state, since the person is unconscious or has limited sensitivity. Allergies in severe cases can provoke:

inhibition of respiratory activity and heartbeat;
changes in blood clotting parameters, which is dangerous during surgery;
deviations in the functioning of human organs and systems, which can be critical for life.

The consequences also appear with a delay in the form of thrombocytopenia, hemorrhagic diathesis, and serum sickness. In severe cases, complications lead to disability and even death of the patient.

Diagnostic procedure

If anesthesia has not been previously used to treat the patient or another drug has been used, then the allergy will be recognized when the first signs appear. Therefore, if you are prone to allergic reactions, you should discuss treatment tactics with your doctor in advance. It would not be superfluous to consult with an allergist or immunologist, who will check for allergies by:

Blood sampling for enzyme immunoassay analysis, which will determine the presence of specific types of antibodies to proteins in the plasma.
Measurements of histamine levels in the blood.
Skin test tests. During the testing process, small incisions are made in the forearm area into which a solution containing a possible allergen is dripped. If swelling or redness occurs, it is concluded that there is a tendency to react to this substance.

Help with allergies

Treatment for an allergic reaction to anesthesia can be carried out urgently and routinely. If manifestations of a systemic nature develop, then it is necessary to carry out resuscitation as an urgent matter:

A tourniquet is placed over the site where the anesthetic was injected.
Adrenaline and Eufillin are injected. They normalize cardiac and pulmonary activity.
Prednisolone is administered to relieve inflammation.
As soon as the condition has stabilized, the patient takes a remedy, for example, Diphenhydramine, Suprastin, Loratadine, etc. Detoxifying agents are also used

As part of routine treatment of an allergic reaction, if the disorder is mild, symptoms are relieved and possible complications are prevented. Treatment is carried out using the following medications:

The remedies will help relieve symptoms and alleviate the condition. Doctors recommend using Zodak, Zyrtec, Erius, Diazolin.
Enterosorbents relieve the load on the gastrointestinal tract system in the presence of digestive reactions - take Polysorb or Filtrum.
To eliminate the manifestations, you can also use local remedies - Fenistil Gel, Allergodil, Visin Alergy.

Prevention

To prevent a possible allergy to the anesthetic, it is necessary to first undergo a test for susceptibility to reactions regarding the action. This will help identify specific intolerances. In this case, the doctor selects another drug to which an allergy has not been identified. In addition, the type of anesthesia can be changed, for example, instead of local anesthesia, general anesthesia is performed and vice versa.

Anesthesia helps alleviate the patient's condition during surgical and other medical procedures. However, it itself can pose a danger in the form of an allergic reaction. Such cases occur relatively rarely, but are not completely excluded. Therefore, before performing anesthesia, you should always inform your doctor about possible sensitivity to the drug.

Toothache and tooth decay are problems affecting people of all ages, including children. But not many people rush to see a dentist, and the reason for this is not only the fear of the upcoming manipulations, but also the fear of anesthesia.

Many people have probably heard that during the administration of painkillers, a person can experience a serious allergic reaction, which is quite difficult to cope with.

You shouldn’t believe all the horror stories about the dangers of anesthesia in dentistry, but you shouldn’t assume that allergies are completely excluded during tooth extraction or treatment.

Hypersensitivity when using anesthetics is quite possible, but its development can be avoided by contacting a qualified doctor.

Features of the use of local and general anesthesia in dentistry

Anesthesia (pain relief) in dentistry is divided into local and general.

Local anesthesia means the introduction of a special drug, under the influence of which the sensitivity of the affected area almost completely temporarily disappears.

The use of anesthetics allows the doctor to perform his work more efficiently, since the patient sits calmly in a chair and does not react to manipulations in the oral cavity.

Local anesthesia is required:

In the treatment of deep caries;
When removing a tooth or pulp;
When preparing the dentition for prosthetics.

Painkillers are often prescribed to treat dental caries in children.

Local anesthesia is divided into several types, these are:

Application, that is, spraying a spray with an anesthetic component onto the gums;
Infiltration;
Conductor;
Intraosseous;
Stem.

The type of local anesthesia is selected depending on what treatment technique will be used in the oral cavity.

Local anesthetics act temporarily, usually within a few minutes to an hour. After this period, the anesthetic components begin to gradually break down and sensitivity is restored.

General anesthesia in dentistry is used much less frequently than local anesthesia.

It is usually prescribed for injuries to the maxillofacial area, removal of a cyst from the maxillary sinuses, or if it is necessary to remove several complex teeth at once.

Drugs used in local anesthesia and general anesthesia

Just ten years ago, the most common anesthetic drugs in dentistry were Lidocaine and Novocaine, and it was their administration that most often caused allergic reactions.

An allergy to lidocaine is explained by the multicomponent composition of this drug, and intolerance to novocaine in most cases occurs due to the presence of a preservative called methylparaben in this medicine.

In modern dental clinics, Lidocaine and Novocaine are practically not used.

Lidocaine can be used as a spray for superficial pain relief before the injection.

The most popular drugs for local anesthesia at present are:

Ultracaine;
Articaine;
Ubistezin;
Mepivacaine;
Scandonest;
Septonest.

The anesthetics listed above are 5-6 times more powerful than Novocaine and Lidocaine almost twice as powerful.

In addition to the main active ingredient, modern painkillers for dental procedures contain adrenaline or epinephrine.

These components constrict the blood vessels at the site of their injection and thus reduce the excretion of the anesthetic component, which in turn lengthens and increases the strength of local anesthesia.

Such drugs are immediately supplied in special capsules, these are original ampoules placed in the body of a metal syringe.

The syringe itself is equipped with a very thin needle and therefore the injection of the medicine into the gums remains practically unnoticed by the patient.

General anesthesia in outpatient dentistry is prescribed to patients strictly according to indications. The anesthesiologist must talk with the patient before the procedure, find out his diseases and assess his state of health.

General anesthesia is divided into inhalation and non-inhalation:

General anesthesia used by dentists does not adversely affect health, and therefore it can be used quite often.

But to ensure that there are no negative reactions, the doctor must first select the correct dosage depending on age and the presence of concomitant diseases.

Allergic reactions possible with local anesthesia

Allergies to anesthetics in dentistry develop very rarely when using modern drugs.

And in general, allergic reactions are characterized by a mild course; severe forms of hypersensitivity, requiring emergency treatment, are considered exceptional cases.

An allergy to anesthesia can manifest itself:

The likelihood of developing an allergic reaction is increased in people who already have a history of allergies. If there is an existing problem, be sure to inform your dentist about this before starting treatment.

Some people are hypersensitive to the preservatives in the anesthetic. Therefore, when the solution is administered, tachycardia appears, sweating increases, chills occur, and there may be dizziness and weakness.

But this does not apply to allergic reactions and, as a rule, such symptoms go away on their own within a few minutes.

Causes of allergies to anesthetics in dentistry

Allergies occur due to increased sensitivity of the immune system to the components of the drug.

Factors predisposing to the disease can provoke such a reaction in the body, these are:

Heredity;
Tendency to all kinds of allergic reactions;
Wrong choice of anesthetic;
Exceeding the dose of the drug when administered.

Based on the causes of an allergic reaction to painkillers, we can say that pathology often develops due to the dentist’s inattention to his patients.

Incorrectly selected dose, incomplete history taking, lack of tests and diagnostic procedures data greatly increase the risk of developing allergies in the dentist's chair.

Sometimes it is not the anesthetic component itself that is to blame for the occurrence of an allergic reaction, but the substances included in the anesthetic as additional components. And most often these are preservatives.

The likelihood of a specific reaction in the body also increases if a drug with a multicomponent composition is used.

Allergy tests for anesthesia

If you repeatedly experience symptoms characteristic of allergic reactions when visiting the dentist, you should consult an allergist.

The doctor will order blood tests to determine the level of immunoglobulins and eosinophils. will allow you to determine the specific type of allergen.

Immediately before the administration of the anesthetic in the dental office, in some cases, tests must be carried out.

Their implementation is especially necessary for those patients who have already had allergic reactions to painkillers or have diseases associated with allergies.

When conducting tests, a minimum dose of the drug for local anesthesia is injected subcutaneously and all changes are assessed within a few minutes.

If there are no skin or general allergy symptoms, then this medicine can be used without fear.

Treatment of the disease

Allergies to anesthetics are treated using the same standard regimens as other allergic reactions. But since in most cases such pathology develops rapidly, first aid in severe cases is provided by a dentist.

If changes occur in the skin and swelling, it is necessary to administer Diphenhydramine or Pipolfen intramuscularly.

If symptoms indicate the development of anaphylactic shock, it is urgently necessary to administer 1 ml of Adrenaline and, if necessary, connect a device for artificial ventilation of the lungs. In the future, they act according to the situation.

If blood pressure drops, then you need to put it on; if cardiac activity worsens, Cordiamine is used.

Usually these measures are enough to interrupt the allergic reaction and restore the functioning of all body systems. But if the symptoms do not stop, then the patient urgently needs to be hospitalized in a hospital - in the intensive care ward.

Fortunately, severe reactions to anesthetics are extremely rare, and their occurrence can be prevented by collecting an anamnesis and careful attention to the choice of dose and the drug itself for pain relief.

If rashes on the body, as well as swelling on the face, persist even after visiting the dentist, you should take it for a while.

It could be

Massage techniques and breathing exercises - treatment methods used for bronchial asthma - help with this perfectly.

Hardening, playing sports, swimming, and cycling have a good effect.

Nutrition also affects the state of immunity; the more a person eats natural and fortified foods, the higher the body’s resistance will be.

When treating allergies to anesthetics, herbal medicines are used:

Oregano, licorice root, calamus and St. John's wort are mixed in equal quantities. Two teaspoons of the prepared mixture are poured into a glass of boiling water, heated on the stove, cooled and filtered. Drink a quarter glass of the drink up to three times a day. You can drink this tea for a month, then take a break for two to three weeks and continue the course for another month.
Licorice root, immortelle, calendula and burdock are mixed and used in the same way as in the first recipe. Treatment with these two herbal mixtures can be alternated.

If skin rashes persist, a bath with the addition of a concentrated decoction of chamomile, string, and elecampane is useful. You can use it every day until the skin is completely cleansed.

Allergies to anesthesia in dentistry are extremely rare. But this does not mean that you need to neglect the rules for the safe use of these products.

You should trust the treatment of your teeth only to those dentists who carefully collect anamnesis and can explain all the features of the anesthetics they use.

is hypersensitivity to drugs used for local anesthesia in general surgery, dentistry, neurology, gynecology and ophthalmology. The pathological process can occur in the form of an allergic and pseudo-allergic reaction. Clinical manifestations are characterized by the development of urticaria, dermatitis, Quincke's edema, anaphylaxis, and bronchospasm. Diagnosis includes studying anamnesis, conducting an allergological study (skin tests, provocative tests, determination of IgE in blood serum, etc.). Treatment: avoidance of contact with the allergen, antihistamines, glucocorticoids, restoration of circulatory and respiratory function.

ICD-10

Z88.4 Personal history of allergy to anesthetic

General information

Allergy to local anesthetics is an increased sensitivity of the body to certain medications used for local anesthesia during minor surgical interventions and medical procedures. True allergic reactions to the administration of an anesthetic are rare; more often the pathological process occurs through the mechanism of pseudoallergy. Hypersensitivity often develops to Ester-type local anesthetics, the chemical structure of which contains benzoic acid esters (novocaine, tetracaine, benzocaine), less often to Amide-containing drugs (lidocaine, trimecaine, articaine, etc.). According to statistics, allergic and pseudoallergic reactions associated with the use of local anesthetics account for 6 to 20% of all cases of drug allergies.

Reasons

Local anesthetics are widely used in various branches of medical practice, primarily in ambulatory surgery, dentistry, ophthalmology, gynecology and endoscopy. There are amino ester (benzocaine, procaine, tetracaine) and aminoamide (lidocaine, trimecaine, melivacaine, articaine, prilocaine, etc.) local anesthetics. These drugs are used in the form of injections, aerosols, drops and creams, and often other components are added to the main agent that provides local anesthesia to reduce the dose of anesthetic and improve the quality of analgesia. Hypersensitivity may occur to any substance contained in the local anesthetic.

True allergy to local anesthetics involving immunological mechanisms is very rare and accounts for no more than 1% of all cases of intolerance to this group of drugs. More often, it is not a true allergy, but a pseudo-allergic reaction to certain components of the anesthetic.

Pathogenesis

In true allergy, in response to repeated administration of a local anesthetic, an immediate IgE-mediated allergic reaction develops within a few minutes, manifested by urticaria and anaphylaxis. The allergic reaction can also be delayed, occurring several hours after repeated contact with the problematic drug. In this case, recognition of antigens by sensitized T-lymphocytes occurs, followed by the synthesis of lymphokines and the development of an inflammatory reaction. In this case, an allergy to local anesthetics manifests itself as local swelling and allergic contact dermatitis.

Immunological mechanisms are not involved in pseudoallergy, and the pathological process develops as a result of direct nonspecific release of histamine located in mast cells and basophils, or activation of the complement system. In case of a false allergy to local anesthetics, the severity of clinical manifestations depends primarily on the dosage of the drug and the speed of its administration.

Symptoms

The main clinical manifestations of allergies to local anesthetics depend on the type of drug hypersensitivity. With the development of an immediate allergic reaction, allergic skin lesions such as urticaria with the appearance of erythema and itchy pink blisters are more often observed.

With the development of a delayed-type allergic reaction, the main signs will be local changes in the skin and subcutaneous tissue: contact dermatitis, erythroderma, erythema nodosum, and less commonly, allergic vasculitis. Pseudoallergic manifestations of intolerance to drugs for local anesthesia are diverse and include skin lesions (local swelling and erythema, widespread skin itching), rhinoconjunctivitis, laryngospasm and bronchial obstruction, enterocolitis and anaphylactoid reactions with arterial hypotension, dizziness, general weakness and fainting.

Complications

Angioedema of the subcutaneous tissue may suddenly occur, which persists for several hours (days) and is especially dangerous when the mucous membrane of the larynx is damaged. A rare but severe manifestation of an allergy to local anesthetics is anaphylactic shock, which is characterized by disruption of the respiratory and cardiovascular systems and, in the absence of timely emergency care, often leads to death.

Diagnostics

Accurate diagnosis of allergies to local anesthetics is often difficult, since there are many causative factors leading to intolerance to this group of drugs. This is a toxic effect due to exceeding the dosage of the anesthetic, and the presence of congenital idiosyncrasy (hypersensitivity) to this drug due to disruption of the body's enzyme systems, and allergies, and pseudo-allergies.

To establish an accurate diagnosis, a thorough collection of general and allergological history, analysis of clinical manifestations of hypersensitivity, consultation with an allergist-immunologist, dermatologist, otolaryngologist and other medical specialists are required. A true allergy to local anesthetics is characterized by the development of symptoms upon repeated use of minimal doses of the problematic drug (5-10 days after the first contact) and an allergic reaction (urticaria, anaphylaxis) that occurs with each subsequent administration of the allergen.

In pseudoallergy, the severity of clinical manifestations of intolerance to the anesthetic depends on its dose and rate of administration. To distinguish between allergic and pseudoallergic reactions, methods commonly used in allergology are performed, such as skin tests and provocative tests. Such studies should only be carried out by an allergist in an institution where all conditions have been created to provide qualified emergency care for possible complications. The safest diagnostic procedures are rinsing (rinsing the mouth with an anesthetic solution for 2 minutes) and a mucogingival test (application of a local anesthetic solution to the gum area for 50 minutes).

To clarify the diagnosis of a true allergy to local anesthetics, a blood test is performed to determine the level of tryptase, histamine, total and specific IgE in the blood serum. Differential diagnosis is carried out with other allergic and pseudoallergic reactions to medications, foods, latex and other components. It is important to distinguish symptoms of intoxication of the body from allergies when high doses of anesthetics are administered. In addition, it is necessary to remember that there are frequent cases of psychovegetative reactions to local anesthetics with the development of vasovagal syncope, panic attack (vegetative crisis) and hysterical (conversion) disorder.

Treatment of allergies to anesthetics

Treatment for allergies to local anesthetics includes avoiding the use of drugs to which there has been a history of intolerance and replacing them with drugs from another group. If such a replacement is not possible, intravenous sedation, intubation general anesthesia, narcotic and non-narcotic analgesics, hypnotic effects, acupuncture and electrical stimulation should be used whenever possible. Providing emergency medical care for allergies to local anesthetics includes infusion therapy, the use of epinephrine, antihistamines and glucocorticosteroids, maintaining circulatory and respiratory function.

Prognosis and prevention

The most dangerous in their consequences are generalized forms of allergies - angioedema and anaphylaxis. In these cases, the prognosis depends on the speed and quality of emergency care. If local manifestations of allergy develop, the prognosis is favorable. To prevent unwanted allergic reactions to local anesthetic drugs, it is necessary to carefully collect an allergic history and conduct skin or provocative tests for anesthetics. Patients undergoing diagnostic testing, dental treatment or surgery under local anesthesia should inform the doctor in advance about their drug tolerance.

The dentist is the most terrible doctor. Of course, this is a humorous statement, but not only children are afraid of visiting the dentist - even adults can find it difficult to cope with panic. Self-control comes to the rescue, sometimes sedatives are required - the practice of using it before filling has long become routine. However, the best way to relax in the chair and let the doctor do his job is to inject an anesthetic, that is, a drug that temporarily blocks pain. A person who seeks medical help does not feel anything in the intervention area - and the specialist freely carries out all the necessary manipulations. Of course, this greatly simplifies the situation for both the doctor and the patient - however, an allergy to anesthesia in dentistry can prevent you from using the anesthesia technique. Unfortunately, it is not so rare - and can lead to a variety of consequences: from skin rashes to anaphylactic shock.

Reasons

Sensitivity to anesthetics used at the dentist is a type of drug intolerance. It may be related:

with the production of special specific immune antibodies (sensitization);
with a pseudo-allergic reaction;
with an overdose of the drug.

The risk of developing symptoms increases:

With rapid administration of the drug.
When using the anesthetic on an empty stomach.
In the case of treating a person exhausted by a long-term illness.

Sensitization is characteristic of the so-called true allergy, while false allergy occurs without the participation of antibodies. The symptoms are the same, so it is not possible to distinguish them without special tests. The likelihood of developing sensitivity is higher in people who have already experienced an episode of drug intolerance, suffer from bronchial asthma, atopic dermatitis, or are receiving many pharmacological drugs at the same time - they can enhance each other’s allergenic potential.

In some people, sensitivity is due to a reaction not to the anesthetic itself, but to additional components:

Adrenaline (Epinephrine);
preservatives;
antioxidants;
stabilizers (sulfite, EDTA);
bacteriostatic additives (parabens);
latex in the ampoule with medicine.

A true allergic reaction to the anesthetic develops only after repeated administration of the drug.

The immune system needs time to produce antibodies, so the occurrence of disturbances during the initial use of the active substance means either the presence of sensitization in the past, or a pseudo-allergy or overdose. This principle works with all medications and methods of pain relief (including if epidural anesthesia is planned). However, there is a nuance: when the patient is already sensitive to a certain pharmacological agent, and it has a similar antigenic structure to the drug administered for the first time, a true allergy can still develop immediately.

Symptoms

Reactions to anesthetics in dental practice can be:

immediate (reagin type);
deferred.

According to statistical studies, most episodes of sensitivity are recorded, on average, an hour or two after medical intervention. This allows you to quickly identify and prevent unwanted reactions in the future, as well as carry out differential diagnosis with similar conditions. However, at the same time, delayed forms are not uncommon, manifesting 12 hours or more after the injection of the anesthetic.

Local (local) signs

This is a group of symptoms, the area of manifestations during the development of which is limited to the contact zone - that is, the site of drug administration. An allergy to anesthesia is characterized by:

Edema.
Redness (hyperemia).
Feeling of fullness, pressure.
Soreness of the gums and teeth - when biting.

The described signs are not dangerous in themselves, but they can develop together with other pathological reactions - urticaria, Quincke's edema. If the clinical picture includes only local symptoms, their relief (cessation) occurs even without treatment after a few days - of course, provided that the anesthetic that caused the development of the disorders is not reintroduced.

Dermatological manifestations

This group includes all types of skin lesions associated with allergic intolerance to local anesthetics in dentistry. They develop in both immediate and delayed modes and are not life-threatening or pose a very significant threat.

Hives

Characterized by the following complex of manifestations:

skin redness;
swelling, severe itching;
the appearance of a rash in the form of blisters;
general weakness;
headache;
increase in body temperature.

Sometimes there is also a decrease in blood pressure (hypotension). The blisters are small or large (up to 10-15 cm in diameter), pink, merging with each other. The fever is called “nettle fever”; thermometry values range from 37.1 to 39 °C. The rash disappears on its own and can persist for up to 24 hours; recurrence after initial relief of symptoms cannot be ruled out.

This is an allergic reaction that is often observed in combination with urticaria; During the development process, different areas of the skin and loose fiber are affected. Localized mainly in the area:

Eyes, nose, lips, cheeks.
Oral cavity.
Larynx, bronchi.

The swelling forms quite quickly, grows over several hours, has an elastic consistency, and rises above the skin level. The most dangerous location is in the respiratory tract (in particular, in the larynx) - this threatens suffocation and, if timely assistance is not provided, death. The clinic includes symptoms such as:

significant swelling of the lips;
pale skin;
difficulty breathing, which gradually increases;
"barking" cough;
dyspnea.

If the gastrointestinal tract is affected, the following appears:

nausea;
vomit;
abdominal pain;
diarrhea.

If the localization of edema is not life-threatening, it can resolve on its own after 10-12 hours. Otherwise, the patient requires emergency medical care to restore airway patency.

This is the most severe consequence of a reaction to a dental anesthetic and has the following symptoms:

Weakness.
Dizziness.
Tingling and itching of the skin.
Urticaria, Quincke's edema.
Nausea, vomiting.
Difficulty breathing.
Sharp pain in the abdomen.
Cramps.

The development of anaphylactic shock is not determined by the dosage of the drug - even a minimal amount can provoke symptoms.

There are several forms of pathology, all of them are characterized by a sharp drop in blood pressure and hypoxia (oxygen starvation) of the body due to poor circulation. They occur at different times: from a few seconds to 2-4 hours from the moment of drug administration.

An allergy to pain relief can also cause symptoms of rhinitis (runny nose), conjunctivitis (tearing, redness and swelling of the eyelids), isolated itching of the skin not accompanied by rashes. Without treatment, pathological signs persist for several days and gradually weaken.

How do you know if you are allergic to anesthesia?

The reaction is caused by the interaction of the drug with immune antibodies of the IgE class. Their detection is the basis of most diagnostic tests, but the first step is to take a history. This is a survey of the patient to assess the nature of symptoms and the likelihood of their connection with allergic intolerance.

Laboratory methods

Their use is widely practiced by dentists around the world to predict the response to anesthetics, filling materials and other components used in the treatment process. However, a positive test result is not yet a diagnosis; the judgment about the presence of an allergy must be supported by other information (for example, anamnesis - objective manifestations observed after injection of the drug in the past).

The most commonly used:

complete blood count (increased number of eosinophil cells);
enzyme-linked immunosorbent, chemiluminescent method for detecting specific antibodies;
determination of tryptase and histamine levels;
basophil activation test.

All methods have different levels and time periods of sensitivity. Thus, determination of tryptase levels can be carried out on the eve of dental surgery (in order to assess the probable risk) or within 24 hours from the moment of symptoms manifestation (maximum values for anaphylaxis are observed after 3 hours, and the increase begins after 15 minutes). The search for antibodies is most often recommended to be performed within 6 months after the allergic reaction occurs.

Recognized as the safest skin test for determining the likelihood of sensitivity to local anesthetics in dentistry. Carried out using:

Compact lancets.
Allergenic substances.
Diluting liquid.
Control drugs (negative, positive).

A solution of the test substance is applied to the skin (usually the forearm). Next to it are control suspensions. Notes are made everywhere. The selected area is then pierced with a lancet, which, when used correctly, does not affect the blood vessels, but ensures rapid absorption of the drugs (and a high level of safety for the patient). The reaction is monitored for a given time - redness, swelling, or a blister indicate a positive result (sensitivity).

Treatment

It is carried out as an emergency (in the dentist’s office, on the street or at home after the development of symptoms) or planned (prescribed by a doctor to eliminate manifestations that are not life-threatening, but cause discomfort).

Limiting the use of allergen medications

This method is also called elimination. The patient must refuse the anesthetic that caused the deterioration of the condition and, if necessary, undergo diagnostics to determine the immunological nature of the reaction. If it is confirmed, the use of a provoking drug in any form should be excluded - it is important to pay attention not to the trade name of the drug, but to the main active ingredient and additional components (if they were the “culprits” of the violations).

It is important to understand that it is not only dental procedures that pose danger. The dentist should be aware of the presence of intolerance, but caution is required in other situations - for example, when using sprays and throat lozenges containing local anesthetics, as well as when preparing for gastroscopy and other procedures that involve the need for local anesthesia.

Drug therapy

To relieve symptoms of allergic reactions, the following are prescribed:

antihistamines (Cetrin, Zyrtec);
topical glucocorticosteroids (Elocom);
sorbents (Smecta, Enterosgel).

In most cases, the drugs are taken orally in tablet form. The use of skin products - ointments, lotions - is required for dermatological lesions accompanied by rash and itching. Sorbents play a supporting role, accelerating the removal of allergens from the body; they are not prescribed to all patients.

For emergency treatment of anaphylactic shock, Adrenaline is required first of all (it is also produced as part of an Epipen syringe pen for self-use). Systemic glucocorticosteroids (Dexamethasone, Prednisolone), antihistamines (Suprastin) and other drugs (Mezaton, Ascorbic acid, solutions for intravenous infusion) are indicated. These drugs are also administered for urticaria and Quincke's edema.

Is it possible to find an alternative to local anesthesia?

The use of painkillers in dental practice has become routine and familiar not so long ago - some experts still suggest doing without an injection. It is worth noting that this, although it sounds scary, is actually a solution for simple manipulations - for example, treating untreated caries. But this option is not for everyone. Firstly, you need to have practically healthy teeth, and secondly, a high pain threshold.

Those patients who are horrified not even by the buzzing sound, but only by the sight of the drill, find themselves in an extremely difficult situation when sensitivity develops. How to treat teeth if you are allergic to anesthesia? There are two options:

Replacing the drug.
Anesthesia (drug-induced euthanasia).

In the first case, it is necessary to select in advance a medicine to which there is no sensitization - for this, diagnostic tests are carried out (prick test, laboratory tests). It is worth considering that the risk of developing sensitivity does not disappear anywhere, and if a lot of time has passed after dental treatment, there is no guarantee that a reaction will not occur - a repeat examination is required.

Tests are performed with the drug that will be administered by the dentist - this way you can assess the likelihood of intolerance to all components contained in the ampoule.

Anesthesia provides a complete absence of pain (the patient is unconscious), but has contraindications - in particular, severe pathologies of the cardiovascular and respiratory systems. It can be characterized by various complications during drug-induced sleep and after waking up - and among them there are also allergic reactions. It is worth discussing the need for anesthesia individually during a face-to-face consultation with a doctor, since it is almost impossible to correctly assess the level of risk and other important points remotely. In addition, the procedure cannot often be repeated, so it is better to plan the treatment of several problematic teeth at a time.