after the surgical wound was treated with value: there is no RIA inhibition with 5. MONERET-VAUTRINDA, RENAUDINJM, a small quantity of betadine® the patient atracurium and the skin tests to curares KANNYG, WIDMER S, HANEsSEB, DEZ- presented with grade 4 anaphylactic are negative. Only 89% specificity has FOULIANB. Prospective study of the latent shock with acute respiratory distress been documented (3-5). Similarly, RIA sensitization to muscle relaxants. In: syndrome requiring intensive resuscita- to penthotal may produce false positive OEHLlNGAK, HUERTA LOPEZJG, editors. tion for 24 h. Sampling performed results (6). Progress in allergy and clinical immunology immediately after the incident showed the Povidone was previously used via the Proceedings of the XVlth ICACI, 19-24 tryptase level to be 39 llg/I and serum IV route as a plasma replacement or as Oct, 1997, Seattle: Hogrefe & Huber histamine level 22.4 nmol/1. a solubilizing agent for injectables. 1997:361-367. Personal history included a previous Doxycycline IV that contained povidone 6. HARLE, DG, BALDOBA, FISHERMM. The surgery for peripheral neurolysis in 2000, was withdrawn from the Pharmacopoeia molecular basis of IgE antibody binding to during which acute urticaria of the left because of anaphylactic reactions. Iodi- thiopentone. Binding of IgE from thiopen- tone-allergic and non-allergic subjects. arm spreading to the neck and face was nated povidone is a skin antiseptic but Mol lmmunol 1990;27:853-858. observed 20 min after swabbing with the case reported here shows the risk of 7. MONERET-VAUTRINDA, MATA E, GERARD betadine®. intra-vascular passage if a little quantity H, TRECHOTM. Probablc allcrgy to poly- Skin tests carried out 9 months after is introduced in a surgical wound. vidone, responsible for a reaction to iodi- the anaphylactic shock on skin reactive to When the patient was questioned later, nated contrast medium: a case of asthma codeine (4 mm) were negative for all it was found that he had had a less after hysterosalpingography. All Immunol curarizing agents. Prick test to betadine® serious reaction earlier. This is the (Paris) 1989;21: 196, 198-199. was positive: 5 mm, intradermal test second case of allergy reported to (IDT) was positive at 10-4 (10 llg/ml); povidone (7). 7.5 mm (injection papula 3 mm), prick Allergy to local anesthetics of test to povidone; 3 mm, IDT to povidone 'Department of Internal Medicine was positive at 10-4; 7 mm (injection Clinical Immunology and Allergology the amide group with papula: 2.5 mm). University Hospital tolerance to procaine Total IgE value was 5000 kIV/1. The 29 avenue de Lattre de Tassigny results of the leukocyte histamine release 54035 Nanay Cedex test could not be interpreted because France M. Morais-Almeida', A. Gaspar, S. Marinho, cellular histamine was lower than normal J Rosado-Pinto (280 nmol instead of 600). Also, the Accepted for publication 29 March 2003 iodinated povidone interfered with the Allergy 2003: 58: 82&-827 histamine assay. The basophil activa- Copyright © Blackwell Munksgaard 2003 Kev words: local anesthetics; drug allergy; tion test (BAT) was positive to betadine® ISSN 0105-4538 ropivacaine; procaine; cross-reactivity. (14 % CD3 +, CD63 + and to povidone: 18% for a negative control at 0.5% References Local anesthetics (LA) are widely used and a positive anti-IgE control at I. SAINTE-LAUDYJ. Application of flow drugs in dentistry and ambulatory sur- 23%). The leukotriene release test was cytometry to the analysis of activation of gery. Adverse reactions to LA are fre- positive to betadine® and to povidone: human basophils. Immunologic validation quently reported but the incidence of 180 and 140 pg/ml (normal limit of thc mcthod. All Immunol (Paris) hypersensitivi- :S 100 pg/ml). Both tests were negative to 1998;30:41-43. ty reactions, like Allergy to amide group 2. LEBELB, MESSAADD, KVEDARIENEY, IgE-mediated atracurium. local anesthetics The radioimmunoassay (RIA) to qua- RONGIERM, BOUSQUETJ, DEMOLYP. reactions are including ropivacaine. ternary ammonium ions was positive at Cysteinyl-Ieukotriene release test (CAST) in rare, being 4.8% but the inhibition test with atracu- the diagnosis of immedia te drug reactions. probably < I % rium was negative. RIA to penthotal was Allergy 200 I;56:688-692. (I, 2). LA are grouped, depending on positive. Serum tryptase values were 3. GUEANTJL, MATA E, MONIN B, MONERET- their chemical structure, into two categ- normal, thus eliminating the acceptable YAUTRINDA, KAMEL L, NICOLASJP, ories: benzoate esters and amides; the clinical explanation that the severity LAXENAIREMe. Evaluation of a new latter group is usually well tolerated. of the shock may be related to latent reactive solid phase for radioimmunoassay In some exceptional reports of allergic mastocytosis. of serum specific IgE against muscle relax- reactions caused by LA of the amide ant drugs. Allergy 1991;46:452-458. Anaphylaxis induced by iodinated group, mainly to lidocaine, other amide 4. GUILLOUXL, RICHARD-BLUMS, VILLEG, povidone is anaphylaxis to povidone, the drugs, such as mepivacaine and ropiva- MOTIN J. Histamine release assay and carrier molecule for iodine atoms. Ana- caine, were usually well tolerated (3). radioimmunoassay for the detection of phylaxis is documented by positive skin We present a 46-year-old woman, IgE antibodies against neuromuscular tests, BAT and cysteinyl-Ieukotriene referred to us for evaluation of tolerance blocking drugs. Ann Fr Anesth Reanim release test (CAST), (I, 2). Positive RIA to LA before the performance of deep 1993;12: 182-186. to quaternary ammonium ions is of no skin biopsies and dental procedures; in ~Net brief, she had anaphylactic reactions after *Serviyo de Imunoalergologia sought to evaluate the response to mite the administration of an unknown local Hospital de Dona Estefania extracts using APT and to skin prick tests anesthetic agent 20 years ago and after 1169 - 045 Lisboa (SPT) in subjects with persistent respir- lidocaine administration 12 years ago. Portugal atory symptoms, AEDS, and with both Five years ago the patient also reported a Fax: +351213126654 the diseases. large local urticaria after topical use of E-mail: [email protected] Eighty-nine patients were included in lidocaine (EMLA® anesthetic disc, the study, 75 (84.3%) children and 14 AstraZeneca, USA). After obtaining the Accepted for publications 12 March 2003 (15.7%) adults, 54 (60.7%) males and 35 patient's consent, the diagnostic Allergy 2003: 58: 827-828 (39.3%) females. They were divided in to approach was carried out. Skin tests were Copyright © Blackwell Munksgaard 2003 three groups of 47, 15, and 27 subjects, performed with commercial LA drugs. ISSN 0 I05-4538 with only respiratory symptoms, only Positive skin-prick test results with full- AEDS, or both, respectively. They strength drug were obtained for lidocaine References underwent usual SPTs with mite extracts (AstraZeneca) with a wheal diameter of I. GALL H, KAUFMANN R, KALVERAM CM. and APTs by mite extract in Finn 5 x 4 mm, bupivacaine (AstraZeneca) Adverse reactions to local anesthetics: chambers, which were removed after with 6 x 4 mm and mepivacaine (Labo- analysis of 197 cases. J Allergy Clin 48 h, with readings after 20 min and 24 h. ratorios lnibsa, Portugal) with 4 x 3 mm. Immunol 1996;97:933-937. Of the 89 patients, 24 showed a posit- Skin-prick test for ropivacaine 2. FISHER MM, BOWEY CJ. Alleged allergy to ive SPT and 69 a positive APT; in 17 both (AstraZeneca) was negative, but the local anaesthetics. Anaesth Intensive Care SPT and APT were positive, while 13 intradermal (TD) test with I : 100 dilution 1997;25:611-614. were negative to both the tests. The APT was positive (12 x 10 mm). Then, we 3. SOTO-AGUILAR MC, DESHAZO RD, DAWSON was more frequently positive than SPT performed skin tests (prick and TD test- ES. Approach to the patient with suspected not only in the two groups with ing) with procaine (Labesfal, Portugal), local anesthetic sensitivity. Immunology AEDS - 32 of 42 (86.5%) vs eight of 42 the LA belonging to the ester group, and Allergy Clinics of North America (21.6%) - but also in the group with only which were negative. On the next day, the 1998;18:851-865. respiratory symptoms - 37 of 47 (78.7%) patient was admitted to an intensive care 4. CUESTA-HERRANZ J, DE LAS HERAS M, vs 16 of 47 (34%). unit for challenge procedures. The FERNANDEZ M, LLUCH M, FIGUEREDO E, These results confirm the high value of subcutaneous challenge with I ml of UMPIERREZ A, LAHOZ C. Allergic reaction APT in patients with mite-induced AEDS procaine (2%) was negative, (three caused by local anesthetic agents belonging and suggest that its routine use might biopsies ~ forearm and thigh), with no to the amide group. J Allergy Clin Immunol improve the diagnosis of respiratory adverse reactions. In order to ensure that 1997;99:427-428. allergy to house dust mites also. the positive skin test results were relevant, we carried out placebo controlled (saline), ·vico S Matteo 3 single-blind subcutaneous challenge test Comparison of skin prick test S. Severo with 0.1 ml of ropivacaine (0.2%, pre- and atopy patch test with dust Italy servative-free solution), and it was Tel: + 39-882-221290 strongly positive (severe systemic reaction mite extracts in patients with E-mail: [email protected] with laryngospasm, treated with paren- respiratory symptoms or teric epinephrine), confirming the diag- atopic eczema dermatitis Accepted for publication 5 March 2003 nosis of allergy to LA of the amide group. syndrome Allergy 2003: 58: 828 The immediate hypersensitivity reaction Copyright © Blackwell Munksgaard 2003 was proved in this case and, as far as we ISSN 0 I05-4538 know, this is the first report of severe hypersensitivity to ropivacaine, a drug unique among LA because it is prepared as an isomer (the S-enantiomer of the Key words: atopy patch test; mite allergy; skin prick Contact dermatitis due to a propyl homologue of bupivacaine) rather test. 'de Ouervain' splint than a racemic mixture. The therapeutic alternative was procaine, the ester anes- The atopy patch test (APT) was intro- thetic, not routinely used nowadays. In duced to assess sensitization to inhalant J. A. De Mateo'. E. Enrique. M. A. Diaz Palacios, conclusion, although ropivacaine is a allergens in patients with atopic eczema J. V. Castello, T. Malek first-choice drug for the majority of LA dermatitis syndrome (AEDS), but its allergic patients, cross-reactivity must be diagnostic role in thought within the amide group, in subjects with Key words: allergic contact dermatitis; 'de Quervain' patients with positive skin tests (4); in respiratory al- Skin prick and atopy splint; orthopaedic splint; polyethylene. these cases, allergy evaluation must be lergy has been patch test in mite accomplished in a reference centre in only scantily allergy. Several components of splints, such as order to identify safe alternatives (3). investigated. We rubber or neoprene, have been implicated