Delayed Hypersensitivity to Lidocaine Cross-Reactivity with Others Amide-Type Anesthetics

We notice a patient consulting for several eczema episodes related to topical ointments containing lidocaine. Study was made, and amyde-type local anesthetics cross-reactivity in this patient, is reported. Usefulness of different diagnostic tests is also discussed. 2%, fluocinolone 0.01%, mentol 0.25%, bismute subgalate 5%), and Hemoal® (benzocaine 3%, ephedrine 0.2%) prescribed as hemorrhoid remedies. Patch-test were carried out (Marti Tor®, Barcelona, Spain), with lidocaine 15% in petrolatum was positive at 48 h (++) and 96h (+++). On the other hand, mepivacaine 1%, triamcinolone 0.1%, dexametasone 0.5%, prednisolone 0.5%, and benzocaine 5% in petrolatum, were negative.Ephedrine 5% in petrolatum, marketed by the hospital pharmacy was negative, too. Intradermal test with 0.02 ml lidocaine 2% (Lidocaina iny. 2% Braun®) was positive at 48 h (++). Also, 0.02 ml mepivacaine 2% (Scandinibsa® 20 mg/ml) showed scarce erithema and a few small vesicles. Intradermal test with bupivacaine 0.5% (Inibsacain 0.5%) and levobupivacaine 0.75% (Chirocane® 0.75%), yielded negative results. Challenge test with 3 cc. subcutaneous levobupivacaine 0.25% (Chirocane® 0.25%) was carried out and the patient exhibited no symptoms. Discussion