The predictive value of skin testing in the diagnosis of local anesthetic XXXX .

@entity1 @entity566
Local anesthetics are commonly used medications and can result in adverse reactions. The diagnostic workup of local anesthetic reactions remains controversial. This study was designed to determine the effectiveness of skin testing for local anesthetic @entity566 evaluation. A retrospective chart review was performed on @entity1 undergoing local anesthetic skin testing. @entity1 were included if they underwent prick and intradermal skin testing followed by incremental subcutaneous challenge. Charts were further systematically reviewed to evaluate response to local anesthetics in the clinical setting after open subcutaneous challenge. One hundred seventy-eight @entity1 underwent 227 local anesthetic skin tests. Two hundred twenty (97%) of the skin tests were negative. Of the negative skin tests results, 214 (97%) had negative challenge or probable non-IgE-mediated events during challenge. Three @entity1 with six negative skin tests had a local reaction during the open subcutaneous challenge. Seven skin tests on five @entity1 met the criteria for a positive skin test with local anesthetics. One @entity1 had an equivocal local skin reaction with subcutaneous challenge without systemic effects. Three @entity1 had a negative subcutaneous challenge and one @entity1 did not undergo a challenge. Ninety-eight percent of @entity1 receiving local anesthetics in the clinical setting after open subcutaneous challenge tolerated the medications. The negative predictive value of the local anesthetic skin test was 97% with few positive skin tests. Positive local anesthetic skin tests are uncommon and the local anesthetic skin tests have an excellent negative predictive value. Additional study with skin test-only protocols is warranted.
