Figen Çelebi ÇELİK, Soner GÜNDER, Özgen SOYÖZ, Canan Şule KARKINER, Özlem SANCAKLI, Demet CAN
Trends in Pediatrics - 2026;7(3):201-209
Objective: Suspected local anesthetic (LA) allergy is a frequent reason for referral to pediatric allergy clinics, particularly from dental settings. However, true drug hypersensitivity is considered rare. This study aimed to determine the frequency of confirmed LA allergy and to identify clinical risk factors in children referred from dentistry. Methods: This retrospective study included children aged 2-18 years referred to a tertiary pediatric allergy unit with suspected LA hypersensitivity between 2015 and 2025. A stepwise diagnostic protocol was used: skin prick test (SPT) at full strength (1:1), intradermal test (IDT) at 1:100 dilution if SPT negative, and subcutaneous drug provocation test (DPT) in two graded steps if both skin tests were negative. True LA allergy was defined as objective positivity on SPT, IDT, and/or DPT, interpreted in the context of the clinical history when an index LA reaction was present. Results: Of 94 referred children, 61 with completed diagnostic evaluation were included in the final analysis. The median age was 9 years (IQR 6.1-12.9), and 45.9% were female. Most referrals were related to allergic comorbidities rather than a prior reaction suggestive of LA hypersensitivity. LA allergy was confirmed in 5 patients (8.2%). Confirmation was significantly more frequent in children with a history suggestive of a prior hypersensitivity reaction to an LA (p=0.024; OR 12, 95% CI 1.2-116) and in those with a history of anaphylaxis (p=0.005; OR 26.5, 95% CI 3.1-223.9). Articaine or prilocaine was also associated with confirmed LA allergy (p=0.012). No positivity was observed in children referred solely because of asthma, food allergy, or chronic urticaria. Among children with negative SPT results, two had positive IDT findings; no positive reactions occurred during subcutaneous provocation in those with negative skin tests. The negative predictive value of undiluted SPT was 96.4%. Conclusion: In children referred from dental clinics, confirmed LA allergy was mainly associated with a convincing prior LA-related reaction history, particularly anaphylaxis, rather than with unrelated allergic comorbidities. These findings support a risk-based diagnostic approach in which high-risk children undergo formal evaluation to confirm allergy and identify safe alternatives, whereas unnecessary testing may be avoided in low-risk patients.
