A 51-year-old male patient, weighing 64 kg, visited our outpatient department with the chief complaint of redness and swelling on the right side of the face that had occurred 3 h after a tooth extraction at another dental clinic. Furthermore, the patient complained of continuous throbbing pain associated with difficulty in chewing food and reduced mouth opening. There was no history of systemic illness. On examination, his vitals were stable; extra-orally, diffuse swelling was noted on the right side of the face along with erythema involving the right cheek, chin, and neck region (). The patient had no other symptoms except for mild itching associated with the erythema. Intra-orally, edema was noted around the unhealed socket of 48. Cone-beam computer tomography revealed a 48 root stump. Considering the patient’s history and examination findings, he was transferred to the Department of Dermatology to rule out any allergic reaction/allergen sensitivity before commencing any definitive treatment (surgical extraction of 48) under local anesthesia.\nSkin prick and intradermal tests were performed using the HollisterStier grading system (Allergy Skin Test Guide/HollisterStier - Sliding Guide Miles []) with five LAs: lidocaine, procaine, articaine, bupivacaine, and ropicaine. Wheel-and-flare reaction was noted only to lidocaine (). Therefore, procaine, with a duration of action shorter than that of lidocaine, was used as the LA for performing the surgical extraction of 48. Continuous monitoring of all vitals was performed for 3 h, and no signs of hypersensitivity were noted. Patient was discharged few hours after the procedure; he was instructed to self-monitor the symptoms and report to the emergency department in case of any symptoms or discomfort.
A 46-year-old female patient, weighing 72 kg, reported to our outpatient department with the chief complaint of pain in the lower left back tooth region for 1 week. Pain was intermittent and sharp in nature. On examination, a grossly decayed 38, which was tender on percussion, was noted. Atraumatic extraction of the tooth was performed under local anesthesia using 2% lidocaine with 1:80,000 adrenaline. After 1.5 h post-operatively, the patient presented erythema and mild swelling on the left side of the face, extending from the zygomatic arch region superiorly to the mandibular inferior border inferiorly and from the corner of the mouth anteriorly to the angle of the mouth posteriorly (). The patient had mild itching with stable vitals and no other typical allergy symptoms (discomfort, choking, or loss of consciousness). Considering her clinical presentation, hypersensitivity reaction was suspected, for which 1–2.5 mg/kg steroid (hydrocortisone) was administered and tablet fexofenadine 180 mg once daily prescribed for 3 days. The erythema and itching was relieved with medication. The Department of Allergy confirmed hypersensitivity response to lidocaine, procaine, and mepivacaine.