Amide LA Allergy Investigation — ORE Part 1 MCQ

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HardPharmacology & TherapeuticsAmide LA Allergy InvestigationORE Part 1

A patient requires restorative dental treatment. They have a documented immediate hypersensitivity reaction to lidocaine, prilocaine and articaine, with generalised urticaria and wheeze shortly after injection. What is the most appropriate next step?

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Correct answer: A — Arrange referral for formal local-anaesthetic allergy testing

The correct answer is **A**. Generalised urticaria and wheeze occurring shortly after injection are compatible with an immediate hypersensitivity reaction. Although true allergy to amide local anaesthetics is exceedingly rare, this history warrants formal allergy assessment rather than an empiric switch to mepivacaine or bupivacaine, which are also amide agents. Testing can clarify whether the reaction was due to the local anaesthetic itself or another cartridge constituent, and identify substances that must be avoided. Topical benzocaine does not provide adequate anaesthesia for restorative treatment. Inhalation sedation may reduce anxiety but is not a substitute for operative local anaesthesia. UK SPS guidance advises referral for allergy testing after immediate or delayed hypersensitivity reactions, via the patient's GP.

Reference: Specialist Pharmacy Service. Managing reactions to dental local anaesthetic injections, Allergy and Reducing risk of reaction. 2024. https://sps.nhs.uk/articles/managing-reactions-to-dental-local-anaesthetic-injections/