ALLERGIC REACTIONS

By : Dr SAIF HASAN ALI

Supervised by Dr SUHAIR
 Allergic reaction or hypersensitivity
 A condition in which the immune system reacts
abnormally to a foreign substance.
 Unwanted immune responses, termed as allergic
or hypersensitivity reactions, are generally
classified into four types.
1.  Hypersensitivity Immediate or anaphylactic
2. Antibody- dependent cytotoxic
3. Complex- mediated
4. Cell-mediated or delayed
Types
 Type I :- Atopic Allergies
 As soon as allergens enter the body
immediately antigen-antibody reaction starts.
 This type of allergy is genetically passed from
parents to children.
 At these allergic types, asthma, angioedema,
urticaria, rhinitis and conjunctivitis can be seen.
 At the most severe type, anaphylactic shock
and death can be seen
 Types
Type II :- Cytotoxic type
 Occurs with the antibody against to the antigen.
 Autoimmune anemia, hemolytic anemia, and
transfusion reactions are exemplified

Type III :- Immune-complex type

• Inflammatory reactions starting with the
binding of antibody and antigen.
 Type IV :- Delayed type allergy reaction

 This type of allergy reactions does not show any

signs.
 Some symptoms may occur after 48 hours of
exposure to the allergen.
 Vesicles on the skin beginning with erythema
and burning and allergic contact dermatitis
followed by thickening of the skin can be the
 Type I and Type IV allergic reactions are
examples of this type of allergy.
common types of allergies to materials used
in dentistry
 Allergic reactions to dental materials
 Rarely, unintended side effects may be caused by
dental restorative materials as a result of toxic,
irritative, or allergic reactions.
 They may be local and/or systemic.
 Local reactions involve the gingiva, mucosal
tissues, pulp, and hard tooth tissues, including
excessive wear on opposing teeth from restorative
materials.
 Systemic reactions are expressed generally as
allergic skin reactions.
 Reactions may be classified as acute or chronic
Allergic Responses to Dental Materials 
 TOXICITY
 INFLAMMATION
 ALLERGY
1. ALLERGIC CONTACT DERMATITIS
2. ALLERGIC CONTACT STOMATITIS
3. ALLERGIC CHELITIS
4. LICHEN PLANUS
 MUTAGENICITY
 INFLAMMATION
 A localized physical condition in which part of the
body becomes reddened, swollen, hot, and often
painful, especially as a reaction to injury or
infection.

• Activation of the
host immune
system
 Allergic Contact Dermatitis 
 It is a form of dermatitis/eczema caused by
an allergic reaction to a material.
 Skin may be red and itchy, swollen and blistered,
or dry and bumpy.
 Arises some hours after contact with the
responsible material. It settles down over some
days providing the skin is no longer in contact
with the allergen. 
 Allergic Contact Dermatitis
• Usually occurs where body surface makes
direct contact with allergen.
• Examples: Monomers of bonding agent- distal
part of fingers & palmer aspect of fingertips
• Acrylic component of dental cements, nickel &
resin monomers
 Allergic Contact Stomatitis
 It is a delayed hypersensitivity (Type IV) reaction
to a chemical in contact with the lining of the
mouth.
 It occurs in people already sensitized to the
allergen.However, it is quite uncommon compared
to contact allergic dermatitis or contact cheilitis,
probably because:
1. Saliva constantly flushes the mouth so chemicals
are diluted and do not stay in contact with
the mucosa for very long
2. There is a good blood supply to the lining of the
mouth meaning any chemical absorbed through the
 Allergic Contact Stomatitis
 Common allergens :-
 chromium, cobalt, mercury, eugenol, components
of resin based materials, & formaldehyde
 Mouthwashes, dentifrices, lozenges, & cough
drops cause burning, swelling & ulceration of oral
tissues.
 Allergic contact cheilitis
 It is allergic contact dermatitis affecting the lip(s).
 It is due to a type IV hypersensitivity reaction
 following contact with an allergen and usually
presents as an eczema-like inflammation of the
outer lip or vermilion margin.

• Major sources of
allergens include Metals
– dental restorations,
orthodontic devices
 Lichen planus
 It is a chronic inflammatory skin condition.
 Types : reticular / erosive / plaque
  When it appears on the oral mucosa, lace or stitch
pattern keratinizations may be present and
accompanied by erosion and ulceration.
 In dental metal allergy cases, it appears at the oral
mucosa attached to the metal restoration that
contains the allergy- positive metal element.
 Allergy to dental materials
 Allergy to Resin Materials Composites
 A study was reported in which patients had
lichenoid-like reactions of lips and patch testing
revealed positive reaction to composite
components.
 Antifungal treatment and replacement of existing
restorations resulted in improvement
 Even though resin-based restorative materials are
considered safe, their constituents (methacrylates)
can leach out and cause allergic contact stomatitis as
reported in a patient with mild erythema in the
gingiva and buccal mucosa.
Allergy to Resin Materials Composites
 Allergy to dental materials
 Allergy to Mercury Associated with Amalgam
Restoration
 Delayed hypersensitivity reactions to amalgam restorations
are seen as erythematous, pruritic lesions on the oral
mucosa and skin of the face and neck. The common
manifestations of these reactions are oral lichenoid lesions
(OLL) 
 on replacing the amalgam with composite or glass ionomer,
the lesions resolved
 Air conditioners, proper ventilation of the operating rooms
and proper handling of amalgam scraps under sulphide
solution can avoid mercury vapor production 
 Allergy to dental materials
 Allergy to Metals Nickel-Chromium
 Nickel is the common sensitizer amongst all
metals
 The clinical signs and symptoms of nickel allergy
include burning sensation, gingival hyperplasia,
numbness on sides of tongue .
 In sensitized individuals, nickel exposure leads to
systemic allergic contact dermatitis [28].
 the Ni-Ti arch wire should be replaced with
stainless steel wire or titanium molybdenum alloy
 Allergy to dental materials
Allergy to Latex Products 
 Polyether component-main causative agent. Repeated

exposure & duration plays important role.

 Dermatitis of hand (eczema) most common adverse reaction

 Localized rashes & swelling to wheezing & anaphylaxis

 Most serious systemic reactions occur when gloves or

rubber dam contact mucous membrane - generalized

angioneurotic edema, chest pain, rash on neck or chest
region and respiratory distress
 Prevention: Use Vinyl gloves or gloves made of other

synthetic polymer gloves:- Polythene gloves. Powder free

gloves. Nitrile gloves.
 Allergy to dental materials
 Allergy to local anstesia
 Adverse effects experienced after administration of
local anaesthetics may be mistaken for allergic
reactions, but often there is another explanation for the
symptoms.
 True allergic reactions to local anaesthetics are either
immediate hypersensitivity reactions (type I –
angioedema, urticaria, pruritus, chest tightness,
wheezing, fall in blood pressure)
 delayed hypersensitivity reactions (type IV – localised
reaction at the injection site, contact dermatitis).
Dental management of an allergic reaction

 Medical history
 Drug history

 Allergy – Type of allergy

 Laboratory tests

Local anesthetics, analgesics, and antibiotics are

the most common drug classes used in dental
practice, and allergic or pseudoallergic reactions
have been reported for each. 
 Local Anesthetics
 Most adverse reactions involving local anesthetics are
misstated as allergy.
 (Syncopal episodes) including brief seizure-like activity,
and cardiovascular events.
 Cutaneous reactions or airway compromise should be
regarded as potentially allergic in nature.
 Pruritus (itching)
 Rash Urticaria (hives)
 Local Anesthetics
1. Para-aminobenzoic acid (PABA) esters
(procaine and tetracaine)
2. Amides (articaine, bupivacaine, lidocaine,
mepivacaine, and prilocaine)
 Esters of para-aminobenzoic acid are the most
common offenders and amide derivatives are
rarely if ever implicated.
 Cross-reactions do not occur among amide
derivatives.
 Allergy to other drugs
 Nonsteroidal Anti-Inflammatory Drugs
Nausea and dyspepsia (upset stomach) are the most common
events labeled by patients as being allergic reactions.
True IgE-mediated reactions to aspirin and NSAIDs have been
confirmed, but they are rare.
 Antibiotics

The penicillins and cephalosporins are the most commonly used

antibiotics in dental
Both have been confirmed as producing allergic and
pseudoallergic reactions.
Approximately 50% of patients with actual IgE reactions to
penicillin lose their sensitivity after 5 years. 
 Management
 Cutaneous reactions include pruritus (itch), rash,
and urticaria.
These reactions are generally mediated by histamine
and can be managed using an antihistamine such as
diphenhydramine (Benadryl).
It can be administered as 25–50 mg by intramuscular
(IM) injection in the deltoid muscle using a 50-
mg/mL concentration (0.5–1.0 mL).
 Management of severe type I
hypersensitivity reactions
 Anaphylaxis is an acute reaction involving the
smooth muscle of the bronchi in which
antigen–IgE antibody complexes form on the
surface of mast cells which causes sudden
histamine release from these cells.
 The potential end result is acute respiratory
compromise and cardiovascular collapse.
Anaphylactic reaction usually takes place
within minutes but may take longer.
 Management of severe type I
hypersensitivity reactions
1. Place the patient in a head-down or supine
position.
2. Make certain that the airway is open.
3. Administer oxygen.
4. Be prepared to send for help and to support
respiration and circulation.
5. If an immediate type I hypersensitivity reaction has
resulted in edema of the tongue, pharyngeal
tissues, or larynx, the dentist must take additional
emergency steps to prevent death from respiratory
failure.
 Management of severe type I
hypersensitivity reactions
1. Call for emergency medical service
2. Inject 0.3 to 0.5 mL of 1 : 1000 epinephrine by an
intramuscular (into the tongue) or subcutaneous route.
3. Supplement with intravenous diphenhydramine 50 to
100 mg if needed.
4. Support respiration, if indicated, by mouth-to-mouth
breathing or bag and mask; the dentist should make sure
the chest moves when either of these methods is used.
5. Check the carotid or femoral pulse; if a pulse cannot be
detected, closed chest cardiac massage should be initiated.
6. Confirm emergency medical service is on their way, and
transport to medical facility if needed. 
Thank you