Title: Oral Angioedema After the Local Administration of Lidocaine in a Pediatric

Patient

Author(s): Kestutis Aukstuolis, MS III

Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania

Introduction
Allergic reactions to lidocaine administration are rare, especially in pediatric
patients. There has been one documented case in the literature of anaphylaxis
following local lidocaine administration in a child. Here we describe a case of
oral allergic angioedema in a child after the administration of lidocaine during a
dental procedure.

Case
A nine year old female presented to her dentist for routine dental restoration.
Fifteen minutes after giving lidocaine for local anesthesia, the patient
experienced swelling limited to the buccal mucosa. The following day, the
swelling progressed to involve the whole face. The patient was given oral
diphenhydramine with incomplete resolution of the swelling. After receiving
prednisolone, the facial swelling resolved.

Methods
Skin prick testing was performed using standard reagents of procaine, lidocaine,
histamine, and a negative control.

Results
Skin prick test results were positive to lidocaine and negative to procaine.
Intradermal skin testing for procaine was negative.

Discussion
Allergic reactions to lidocaine are rare, even more so in children. The only other
known documented case was a 4 year-old child who exhibited systemic
anaphylaxis following local lidocaine also during a dental procedure. Local
anesthetics are primarily divided into two major classes- esters and amides. Our
patient displayed sensitivity to amides, which matched her clinical history.
However, she tolerated testing to ester group of anesthetics, which we
recommended be used if future anesthesia is needed.

Conclusion
This case is the second documented case of lidocaine sensitivity in a child. Our
patient displayed symptoms of an allergic reaction with angioedema secondary to
amide anesthetics with subsequent tolerance to ester class anesthetics. This
case shows the importance of testing both classes of local anesthetics to
thoroughly evaluate potential risk of allergic reaction to local anesthetics and
alternative treatment options.