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03.12.2017, 11:11
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Аллергия на локальные анестетики
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Да, такие провокационные пробы проводят только в специализированных центрах, но, если их не проводят в каждом аллергологическом отделении , это не означает, что их нет вовсе. [Ссылки доступны только зарегистрированным пользователям ] Skin prick tests In the 23 large series, 2487 out of 2978 patients (83.5%) were tested using this method. Thirty (1.2%) had positive results. Most of the patients were tested to more than one Intra-dermal tests Intra-dermal tests have been used variably, either with or instead of SPTs in the initial investigation of these patients. Of 2978 patients, 2648 (89%) had intra-dermal testing. Thirty-seven of these were positive (1.4%) when using 1:10 or greater dilutions of LA. Neat preparations of LA were not commonly used for intra-dermal testing. [Ссылки доступны только зарегистрированным пользователям ] Allergy Clin Immunol. 1984 Oct;74(4 Pt 2):606-16. Skin testing and incremental challenge in the evaluation of adverse reactions to local anesthetics. [Ссылки доступны только зарегистрированным пользователям ] Skin testing is a useful diagnostic procedure in these patients. Skin testing protocols are standardized for penicillin, and are well described for local anesthetics19 and muscle relaxant agents. 19. deShazo RD, Nelson HS. An approach to the patient with a history of local anesthetic hypersensitivity: experience with 90 patients. J Allergy Clin Immunol. 1979;63:387–94. [Ссылки доступны только зарегистрированным пользователям ] Local Anesthetics To exclude the rare possibility of an IgE-mediated reaction to local anesthetics, skin testing and graded challenge can be performed in patients who present with a reaction history suggestive of possible IgE-mediated allergy to these drugs. (B) [Ссылки доступны только зарегистрированным пользователям ] Local anesthetics True allergic reactions to local anesthetics (e.g., novocaine, lidocaine) are extremely rare; reactions are usually due to other ingredients in the medication, such as preservatives or epinephrine. However, if the reaction history is consistent with a possible immediate, IgE-mediated (type I) reaction, skin testing followed by graded challenge tests using epinephrine-free, preservative-free local anesthetics may be utilized [1]. Skin testing protocols are standardized for penicillin, and are also useful (but rarely positive) for local anesthetics, muscle relaxants, and very sensitive for high-molecular-weight protein substances, such as insulin or monoclonal antibodies. [Ссылки доступны только зарегистрированным пользователям ] Evidence from this review confirms the rarity of IgE-mediated allergy to LA and supports an investigation strategy based on using the clinical history to select patients for skin testing and challenge. We believe that such a triage process would alleviate pressures on allergy services without compromising patient safety. [Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] Otherwise, an allergy test will show which of the -caines are safe for you. Из аптудейт (2013): Skin testing and challenge Testing procedures — There are several approaches to skin testing and challenge with LAs. The approach described herein is that of the author and has proven clinically useful: • Prick (epicutaneous) testing with undiluted drug is performed initially. • If prick testing is negative, intracutaneous (intradermal) testing should be performed with a 1:100 dilution of drug. Undiluted group I drugs have been reported to yield positive intradermal tests in up to 20 percent of subjects with no history of an adverse LA reaction. Use of 1:10 dilutions has not been extensively reported, although some guidelines do include this concentration. However, we advocate the use of a maximum dilution of 1:100 for intradermal testing, since false positive skin tests have not been reported with this concentration . An approach to the patient with drug allergy: Despite this limitation, medications for which skin testing for immediate reactions with the native (unmetabolized) form has proven useful in identifying a subset of allergic patients include the following: ...Local anesthetics .... Итогом наших вводящих в заблуждение рекомендаций являются вот такие посты Цитата:
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