Contact allergy and cross-reactions caused by prilocaine.

BACKGROUND: Allergic contact dermatitis from local amide anesthetics such as lidocaine (Xylocaine), bupivacaine (Marcaine, Bicain), mepivacaine (Carbocaine), etidocaine (Duranest), and prilocaine (Citanest) is rare. Allergic contact dermatitis from prilocaine has been reported only from EMLA cream.

OBJECTIVES: We report on a patient sensitized from prilocaine used as a local infiltration anesthetic.

METHODS: Conventional patch testing with various local amide anesthetics as well as intracutaneous tests with amide anesthetics were performed.

RESULTS: Patch testing with EMLA cream (as is) (Astra, Sweden), containing prilocaine and lidocaine provoked an allergic patch test reaction, whereas patch testing with lidocaine was negative. Patch testing with Citanest containing 2% prilocaine and adrenaline was positive. Also articaine gave an allergic patch test reaction, whereas mepivacaine, benzocaine, and caine-mix were negative. Intracutaneous tests with prilocaine and articaine were positive.

CONCLUSION: Our patient had been sensitized from prilocaine and cross-reacted to articaine, but not to other amide anesthetics. Cross-reactions between prilocaine and amide anesthetics were reviewed. As there seem to be no clear rules regarding cross-reactivity among various amide anesthetics, it is safest to test as many amide type anesthetics as possible in case of a delayed type allergy to any member of this family.