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Case Report


Cross-Reactivity Among Amide-Type Local Anesthetics in a Case of Allergy to Mepivacaine


P González-Delgado,1 R Antón,2 V Soriano, 1 P Zapater, 3 E Niveiro 1

1 Sección Alergia, Hospital General de Alicante, Alicante, Spain
2 Servicio de Anestesia, Hospital General de Elche, Alicante, Spain
3 Servicio de Farmacología, Hospital General de Alicante, Alicante, Spain

J Investig Allergol Clin Immunol 2006; Vol. 16(5): 311-313



Among the various adverse reactions to local anesthetics, IgE-mediated reactions, particularly to the more commonly used amide group, are extremely rare. We report the case of a 39-year-old man who suffered itching and generalized urticaria with facial angioedema 15 minutes after administration of mepivacaine. Skin tests revealed a strong positive reaction to mepivacaine, lidocaine, and ropivacaine, but negative reactions to bupivacaine and levobupivacaine. Furthermore, double-blind placebo-controlled subcutaneous challenge with bupivacaine and levobupivacaine was well tolerated.
We conclude that an extensive allergologic study must be carried out in rare cases of true allergic reaction to amide-type local anesthetics in order to rule out cross reactivity.

Key words: Local anesthetics. Amide group. Allergy. Mepivacaine. Lidocaine. Ropivacaine. Bupivacaine.Levobupivacaine