Reactions 778 - 20 Nov 1999

Bupivacaine/lidocaine

Hypersensitivity: case reportA 26-year-old woman experienced several episodes of

hypersensitivity to the local anaesthetics lidocaine andbupivacaine, and demonstrated cross-sensitivity to othergroup II (amide) local anaesthetics.

The first episode of hypersensitivity occurred after thewoman had used an aloe vera gel containing lidocaine[strength and frequency of administration not stated]. Shedeveloped localised redness and pruritus after using the gel onseveral occasions. She subsequently experienced a similarreaction after using an antibacterial ointment containing a localanaesthetic thought to be lidocaine.

The woman later underwent toenail surgery with use of localanaesthesia with bupivacaine [dosage not stated]. Theprocedure was uneventful. However, approximately 8 hoursafter the bupivacaine injection, she began to experiencepruritus at the injection site. Localised redness and swellingalso developed during the next few days.

Approximately 1 year after the first episode ofhypersensitivity, and while 6 months’ pregnant, the womanunderwent patch tests to find an anaesthetic that could beused for local or regional anaesthesia during delivery. Patchtests were positive for lidocaine, mepivacaine and ropivacaine,but were negative for chlorprocaine.

The woman subsequently required a caesarean section fordelivery of her baby. This was performed under spinalanaesthesia with chlorprocaine and was not associated withany immediate or delayed hypersensitivity reaction.

Author comment: It is generally reported that there isextensive cross-reactivity among group I (ester) localanaesthetics such as procaine and chlorprocaine. Whereas,group II (amide) agents such as lidocaine, mepivacaine,ropivacaine and bupivacaine are not felt to cross-reactsignificantly. However, this patient had strong contactsensitivity reactions to multiple group II local anaesthetics.Redfern DC. Contact sensitivity to multiple local anesthetics. Journal of Allergyand Clinical Immunology 104: 890-891, Oct 1999 - USA 800804902

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Reactions 20 Nov 1999 No. 7780114-9954/10/0778-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved