A case of immediate-type allergic reactions to multiple amide local anesthetics

A woman in her 60s had nausea, wobbling and tachycardia during dental treatment under local anesthesia with lidocaine hydrochloride approximately 20 years ago. She recovered from her symptoms by resting. Half a year ago, while undergoing tympanotomy under local anesthesia with lidocaine hydrochloride at otolaryngology, similar symptoms appeared. She visited our clinic for the purpose of resecting an epidermal cyst on the left elbow at this time. We suspected that she had a type I allergy to lidocaine hydrochloride, and therefore conducted a skin test for amide-type local anesthetics and ester-type local anesthetics. Positive reactions were observed for lidocaine hydrochloride, dibucaine hydrochloride and bupivacaine hydrochloride, which are all amide-type local anesthetics. Allergy to amide-type local anesthetics is very rare, but cross reaction between amide types may be relatively frequent. As for this case, cross reaction was suggested.