A 41-year-old female patient received an injection of lidocaine containing epinephrine for root canal treatment, and then, about 30 min later, symptoms of dizziness and systemic urticaria appeared. The patient was determined to be hypersensitive to lidocaine and transferred to the department of allergy.\nSkin prick testing was performed using lidocaine, procaine, bupivacaine, mepivacaine, chirocaine (levobupivacaine), ropivacaine, and articaine, and the patient tested positive to lidocaine, ropivacaine, and articaine (). Among the drugs to which she had tested negative, lidocaine, procaine, mepivacaine, and bupivacaine were used for a skin test, in which a positive reaction was seen only with lidocaine.\nRestorative treatment was performed using procaine, to which the patient had tested negative in the skin test, but it was ineffective as a result of its shorter duration of activity than lidocaine, resulting in the appearance of adverse effects, such as increased anxiety in the patient. Subsequent treatments were performed using levobupivacaine, with which satisfactory treatment effects, in terms of pain reduction and duration, were achieved.
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.