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Lidocaine에 의한 아나필락시스 및 특이 immunoglobulin E 측정
여진엽 ( Jin Yeop Yeo ),김경은 ( Gyung Eun Kim ),한주영 ( Ju Young Han ),임재형 ( Jae Hyoung Im ),박성욱 ( Sung Wook Park ),김철우 ( Cheol Woo Kim ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.1
Although local anesthetics can cause adverse drug reactions (ADRs), most ADRs to local anesthetics are from vasovagal, toxic, or anxiety reactions, while immunoglobulin E (IgE)-mediated anaphylaxis is extremely rare. We report a case of IgE-mediated anaphylactic reaction to lidocaine. A 27-year-old male patient who had two episodes of anaphylactic reactions after local injection of lidocaine was referred to our clinic for the safe use of local anesthetics for the subsequent dental procedure. Skin prick and intradermal tests were performed with amide local anesthetics; lidocaine, bupivacaine, mepivacaine, and ropivacaine. Lidocaine and mepivacaine showed positive response in prick test, and lidocaine, mepivacaine, and bupivacaine showed positive reactions in intradermal test. Only ropivacaine showed negative response both in prick and in intradermal test, and the patient was successfully treated with it. To detect serum-specific IgE, we prepared lidocaine-human serum albumin (HSA) conjugate. Enzyme-linked immunosorbent assay result showed high level of specific IgE to lidocaine-HSA conjugate in serum of the patient. This case suggests that local anesthetics can elicit specific IgE-mediated allergic reactions, and both skin prick and intradermal test should be performed in case of suspected IgE-mediated allergic response to local anesthetics. (Allergy Asthma Respir Dis 1(1):98-101, 2013)