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 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.