Immediate Articaine Allergy in Pediatric Dentistry: A Case Report of IgE-Mediated Hypersensitivity

Local anesthetics (LAs) are widely used in dentistry and minor surgical procedures in children and are classified into two groups: esters and amides. Articaine, an amide derivative, is among the most effective and well-tolerated agents for dental procedures. Commercially available formulations are often combined with epinephrine. With the widespread use of these agents, reports of hypersensitivity reactions have emerged. We describe the case of an 11-year-old girl with asthma who developed immediate hypersensitivity to articaine during a dental procedure and was subsequently referred for allergological evaluation prior to additional dental care. Allergy to articaine, as with other LAs, is estimated to occur in approximately 1% of suspected cases. Most hypersensitivity reactions are attributed to vasovagal mechanisms related to anxiety, direct pharmacologic effects of epinephrine, or allergy to preservatives contained in anesthetic preparations. Allergological evaluation, guided by a thorough clinical history, involves performing skin prick tests, intradermal tests, and drug provocation tests based on the results of initial skin testing, in accordance with current guidelines. In our patient, the provocation test confirmed an IgE-mediated allergy to the LA, evidenced by cutaneous reactions and bronchospasm, along with elevated serum tryptase, highlighting the severity of the reaction. This case adds to the limited literature on LA allergy and underscores the importance for dental practitioners to recognize such reactions, acquire appropriate management skills, and ensure the availability of emergency treatments to address potential hypersensitivity events.