Allergic reactions may manifest as pruritus, erythema, rash, urticaria, angioedema, wheezing, asthma (coughing, difficulty breathing); and, rarely, anaphylaxis.2,4-10,20,21,28-31 Allergic reactions to ester-type LAs have been confirmed. Ester-type anesthetic agents are metabolized by plasma cholinesterase. One of the metabolites, para-aminobenzoic acid (PABA) is a highly antigenic compound capable of sensitizing lymphocytes or eliciting the formation of IgE antibodies.
True allergy to amide-type LAs is rare.2,4-10,20,21,28-31 However, LAs with a vasoconstrictor contain metabisulfite that may precipitate an allergic reaction.6-10,32,33 The prevalence of sulfite allergy in the general population is unknown, but sulfite sensitivity is seen more frequently is patients with asthma. Patients allergic to ester-type LAs have not shown cross sensitivity to amide-type LAs and cross sensitivity among members of the amide-type LAs has not been reported.
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