OBJECTIVE: To review the pharmacology and mechanisms by which local anesthetics cause allergic reactions. Recommendations concerning appropriate use of local anesthetics and alternative therapies in patients with documented local anesthetic allergies are given. DATA SOURCE: A MEDLINE search of English-language literature identified pertinent clinical studies, case reports, and reviews. The periods of review were Med1, 1990-present, and Med2, 1985-1989, using the MeSH terms drug hypersensitivity and anesthetics. References from the selected studies, case reports, and reviews were reviewed.
The effect of kissing on allergen-induced skin wheal responses and plasma neurotrophin levels were studied in 30 normal subjects, 30 patients with allergic rhinitis (AR), and 30 patients with atopic dermatitis (AD). All of the patients with AR or AD are allergic to house dust mite (HDM) and Japanese cedar pollen (JCP). They are all Japanese and they do not kiss habitually. The subject kissed freely during 30 min with their lover or spouse alone in a room with closed doors while listening to soft music.
Cutaneous reactivity against histamine skin prick test (Type I) and purified tuberculin protein derivative (Mantoux reaction, Type IV) was studied in eight volunteers under hypnosis. Types I and IV immunoreactivity were modulated by direct suggestion (Type I) and guided imagery (Type IV). The volunteers were highly susceptible subjects, selected by means of the Harvard Group Scale of Hypnotic Susceptibility, Form A.
The effect of psychological pain reduction on the cutaneous inflammatory process was investigated by studying the effect of hypnotically induced analgesia on the flare reaction of cutaneous histamine prick tests. Ten highly hypnotically susceptible volunteers had their cutaneous reactivity against histamine prick tests on both arms measured before hypnosis. Their pain-related brain potentials were measured on the basis of eight argon laser stimulations. These measurements were repeated in the hypnotic condition, where subjects were given repeated suggestions of analgesia in one arm.
Cutaneous reactivity to challenge with dinitrochlorobenzene (DNCB) and diphenylcyclopropenone (DCP) was studied in 16 volunteers following hypnotic suggestions to increase and decrease response during sensitization. The immunoreactivity to DNCB and DCP was modulated by direct suggestions and guided imagery under hypnosis. The volunteers were highly susceptible subjects selected by means of the Harvard Group Scale of Hypnotic Susceptibility, Form A. Measurement of skin reactions to the challenge 1 month after sensitization was performed double blindly.