The incremental challenge test in the diagnosis of adverse reactions to local anesthetics

Objective, The aim of this study was to assess the reliability of a diagnostic protocol, the incremental challenge test (ICT), for patients with and without a history of adverse reactions to local anesthetics (LAs) or other drugs, to select an LA that could be safely used. Study design. The ICT was performed on 432 subjects, 314 female and 118 male. Four hundred thirty-two challenges were carried out with LAs that were free of adrenaline and preservatives. Chi-square analysis was performed to evaluate the existence of different predispositions to ICT positivity among subjects of the 4 categories studied. Results. Four hundred fifteen tests were completed with no clinical events occurring. The analysis did not show any significant difference (chi-square = 6.17; P > .05). Conclusions, Our results confirm that immunoglobulin E-mediated reactions to LAs are uncommon and that the ICT offers safety and specificity in diagnosing adverse reactions to LAs, allowing for the selection of a safe and reliable LA.