D3.263 - Rare case of anaphylaxis to lidocaine in skin testing during perioperative anaphylaxis investigation

Justification: Immediate reactions to local anesthetics (LA) are considered rare, with an estimated incidence of between 0% and 1% after allergic investigation. Objective: To describe a case of anaphylaxis to lidocaine during the investigation of perioperative anaphylaxis (POA) associated with cutaneous reactivity with cefazolin. Case: Woman, 66 years old, history of APO during laparoscopic cholecystectomy. The medical report showed an initial reaction with skin rash and refractory arterial hypotension, requiring adrenaline, hydrocortisone and noradrenaline. The surgery was suspended and he was admitted to the ICU. The anesthetist's summary reported the use of: fentanyl, lidocaine, propofol, suxamethonium, cisatracurium, cefazolin, dipyrone, dexamethasone, ondansetron, and nalbuphine hydrochloride. He reports a history of allergy to Benzathine penicillin in childhood, but uses amoxicillin without reaction. He had a history of varicose vein and dental surgery, and an aesthetic procedure with lidocaine. Tests for tryptase and IgE for latex were normal. Tests with all reported medications, including chlorhexidine and latex, were negative, except cefazolin and lidocaine. The intradermal test with cefazolin showed pseudopods. The test with lidocaine was the last to be performed, on a different day. Fifteen minutes after the ID test with lidocaine without vasoconstrictor 1:10, the patient complained of blurred vision, progressing to cyanosis, thin pulse, decreased level of consciousness, BP: 67x47, Sat: 84%, HR 132 and hypophonetic sounds. She was treated with a rapid phase, adrenaline, hydrocortisone and diphenhydramine with improvement and was hospitalized for 24 hours. The patient underwent cholecystectomy again, without complications. Conclusion: The investigation of APO must be complete, even in the case of reactivity to the test. Although we have already published several allergic reactions during skin tests, this was the first with local anesthetic, which although rare should not be neglected.