Diagnostic evaluation of suspected immediate hypersensitivity to local anesthetics in children: A single-center experience

Background: Local anesthetics (LAs) are widely used in pediatric surgical and dental procedures and are generally regarded as safe. Nevertheless, children are frequently referred to pediatric allergy clinics because of suspected allergic reactions following LA exposure, despite the rarity of true IgE-mediated hypersensitivity. Objective: To evaluate the clinical characteristics and diagnostic testing outcomes of pediatric patients referred for suspected immediate-type hypersensitivity reactions to local anesthetics. Methods: We retrospectively evaluated children with a history of suspected immediate-type hypersensitivity reactions to LAs and who underwent diagnostic testing. A guideline-based diagnostic algorithm including skin prick testing, intradermal testing, and drug provocation testing was applied. Follow-up was conducted by telephone to assess tolerance during subsequent real-life exposure to local anesthetics. Results: A total of 43 children were evaluated (26 girls; median [IQR] age, 8.3 [6.6–13.5] years). The most frequently tested local anesthetics were lidocaine (n = 15; 34.9%) and articaine (n = 13; 30.2%). Three patients (6.9%) had positive intradermal test results suggestive of hypersensitivity, whereas no reactions were reported during subsequent exposure in patients with negative diagnostic test results. Conclusion: In this cohort, suspected immediate-type hypersensitivity to local anesthetics was rarely supported by diagnostic testing. A structured diagnostic approach allowed identification of a tolerated local anesthetic in most children, facilitating safe use when needed.