Allergy to lidocaine: symptoms, treatment, alternative

Lidocaine is widely used in medicine as an anesthetic and antiarrhythmic agent. Due to the prevalence and availability of this drug, allergy to lidocaine creates great difficulties for doctors and their patients.

Why is lidocaine allergic?

Lidocaine has a complex chemical composition and is metabolized in the liver. The intermediate products of its decomposition are active metabolites. Combining with proteins, they form complexes that can cause allergic reactions. It is worth noting that lidocaine itself, like many other anesthetics, has on the cells of the body toxic effects, because it has the ability to change the physicochemical properties of cellular membranes. In this regard, there is always a high probability of developing side effects, which are often confused with allergies.

A negative reaction to lidocaine often occurs in children and the elderly. This is due to the peculiarities of the functioning of the liver, which processes the drug. In newborns, the enzymatic system has not yet formed, and in the elderly, blood flow in the liver is slowed down. Therefore, the elimination of lidocaine metabolites takes much longer. For the same reasons, lidocaine allergy is a common occurrence in chronic kidney and liver diseases.

In the composition of preparations with lidocaine there are additional substances that are also potential allergens.

1. Stabilizers or sulfites can trigger asthma attacks in some people.
2. Preservatives (parabens) cause allergic reactions especially often, because they are found in almost all cosmetics and household chemicals. Regular penetration of parabens into the body leads to its sensitization.
3. Some anesthetics containing lidocaine or novocaine include EDTA disodium salt. It can irritate the skin, mucous membranes of the eyes and respiratory tract, causing symptoms of bronchitis and allergies.

In some cases, it is not lidocaine or novocaine that provokes negative reactions at all, but latex particles from which consists of rubber stoppers of flasks or medical instruments (gloves, tubes, harnesses, catheters).

Symptoms of a lidocaine allergy

As a rule, an inadequate immune response to lidocaine, novocaine and other anesthetics manifests itself in the form of dermatitis. The symptoms of this condition are as follows:

• severe itching of the skin;
• redness of the skin;
• urticaria rash (urticaria);
• increased body temperature (drug fever);
• induration and pain at the injection site.

In addition, there may be signs of rhinitis and conjunctivitis:

• nasal congestion;
• runny nose;
• poor tolerance to bright light;
• redness of the sclera and conjunctiva of the eyes;
• feeling of "sand" under the eyelids;
• lacrimation.

A severe immune response is the development of Quincke's edema and anaphylactic shock. Therefore, if symptoms of this condition occur (hoarseness, difficulty swallowing, attacks of suffocation, swelling of the lips, cheeks, eyelids and extremities), it is necessary to urgently consult a doctor. It is worth noting that allergies do not always appear after the first use of the drug, since the development of hypersensitivity takes some time. In this regard, repeated administration of the drug, even at the lowest dosage, can cause a violent allergic reaction.

It is necessary to distinguish between the symptoms of toxic effects, which are novocaine, lidocaine and other anesthetics exert on the body in case of an overdose, because the fight against such a condition is not conducted in the same way as with allergies. Intoxication manifests itself

• severe dizziness;
• nausea and vomiting;
• a drop in blood pressure;
• headache;
• convulsions;
• slowing down the heart rate;
• in children, the frequency of respiratory movements slows down until breathing stops.

To find out exactly which substance caused the development of a negative reaction, diagnostic studies are carried out: determination the level of immunoglobulins, the search for specific antibodies, the evaluation of the results of skin and intradermal tests, subcutaneous provocative tests.

Anesthetic allergy treatment

In addition to refusing to further use the drug, it is necessary to carry out activities aimed at eliminating allergens from the body: drink as much pure water as possible, take enterosorbents ("Smecta", "Polyphepan", white coal) and exclude foods with allergens. In severe allergies, diuretics are prescribed (Furosemide, Veroshpiron), and infusion therapy is performed. If symptoms of angioedema or anaphylactic shock appear, corticosteroids and adrenaline may be used in addition to antihistamines.

Often, if you are allergic to lidocaine or novocaine, you cannot do without systemic antihistamines (Diphenhydramine, Suprastin, Tavegil). If the patient has symptoms of urticaria, it is advisable to use topical creams and ointments "Fenistil-gel", "Gistan N", "Advantan". To eliminate the signs of rhinitis, nasal drops "Galazolin" or "Azelastin" are prescribed.

Prevention of lidocaine allergy

To reduce the risk of developing allergic reactions, try to use less cosmetics and household chemicals that contain parabens. Warn your doctor in advance about the presence of chronic diseases so that he can find the optimal dosage. If you wish to substitute one anesthetic for another, be aware of the existence of an allergic cross-reaction. If lidocaine causes an allergy in a person, then there is a high probability of developing a negative reaction to

• mepivacaine;
• prilocaine;
• bupivacaine;
• articaine.

In addition, lidocaine is part of many combination drugs, for example, this anesthetic contains Strepsils Plus, Proctoglyvenol, Otipax. Therefore, before using agents with anesthetic effect, carefully study their composition.

In case of a negative reaction to lidocaine, novocaine is usually used as an alternative, since there is no cross-allergy between these anesthetics. If novocaine also causes unpleasant symptoms, then you can replace it with diphenhydramine.

It is recommended to exercise special care for people whose close relatives have allergic reactions to anesthetics, since this feature of the body can be inherited. Before using such products, it is advisable to check for allergies using special tests.