Preprocedural evaluation and management of suspected history of local anesthetic (LA) allergy if LA would ordinarily be used

LA: local anesthetic; IgE: immunoglobulin E.
* Anaphylaxis due to LAs is rare, and the literature consists of case reports. Refer to the UpToDate topic on allergic reactions to local anesthetics, section on urticaria and anaphylaxis.
¶ Refer to the UpToDate topic on allergic reactions to local anesthetics, section on contact dermatitis and delayed local swelling.
Δ Decisions to potentially delay the procedure for testing will depend upon the risks of delaying the procedure and the risks/benefits of the use of LA versus other forms of anesthesia or analgesia.
◊ Lidocaine is chosen in preference to other LAs because it is among the most commonly used LAs and yet there are few reported cases of anaphylaxis and also because there are cases of tolerance to lidocaine even in patients who reported previous reactions to lidocaine.