Dental Patients, Dental Staff & Dentists
A Letter to Our Dentist Colleagues
Dear Dental Surgeon:
Local Anesthetic Allergy, Latex Rubber Allergy, Dental Metal and Acrylic Allergy, and Penicillin Allergy are some of the areas where we can help you serve your patients better, as follows:
Local Anesthetic Allergy:
When presented with a patient who claims to be allergic to one or more Local Anesthetics, the important question is whether there is risk of cross-reactive anaphylaxis even if you administer a different anesthetic. We can answer that question for you.
Lidocaine is the most common culprit patients blame for previous allergic reactions. Therefore we suggest testing with one of the following three amide anesthetics that do not cross-react with Lidocaine or between themselves: Prilocaine, Mepivacaine and Bupivacaine. We request that you send a 5 ml ampoule of the drug you choose (without Epinephrine in it) with the patient you refer for testing.
Using protocol based on Practice Parameters published by the American Academy of Asthma, Allergy and Immunology, we will skin test with serial dilutions, followed by a graded challenge under close observation, until finally 0.5 ml of the anesthetic is administered subcutaneously. Absence of any local or systemic allergic symptoms in the thirty-minute observation period rules out IgE mediated allergy and ensures that the patient’s risk of anaphylaxis from the tested drug is no greater than that of general population. If the patient does show possible allergic symptoms on testing they are tested with a different amide anesthetic on a subsequent day.
What to do when a patient requires an antibiotic but claims to be allergic to Penicillin.
Up to 10% of US population claims to be allergic to Penicillin. When tested, only 1 or 2 out of the 10 turn out to be truly allergic. Thus 80-90% of your patients claiming allergy to Penicillin can safely take Penicillin and related antibiotics after testing. Unless tested, they would all be prescribed a broad spectrum antibiotic such as a Macrolide, Quinolone or, if inpatient, a Penem, exposing them to greater risk of C.Diff and Candida infections, greater cost, more toxicity and, worst of all, increasing the risk of superbug evolution in the community.
Penicillin Allergy Testing is a simple procedure. After serial skin testing with the Major and Minor Determinant Antigens of Penicillin, patient is given a graded oral challenge with a B-Lactam Antibiotic such as Amoxicillin or Pen V, under observation in our office. If the skin tests are negative and there are no symptoms after a full dose of the antibiotic, the patient’s risk of anaphylaxis from a Beta-Lactam drug is the same as that of general population. Infectious Disease specialists now recommend that all patients claiming to be allergic to Penicillin be pre-tested so as to reduce the use of broader spectrum antibiotics for situations that need Penicillin, such as prophylactic use in dental procedures.
Latex Rubber Allergy:
Anaphylactic as well as contact allergy to latex rubber is becoming increasingly common. Whether it is your staff or a patient claiming to be allergic to Latex, we can evaluate the type, extent and seriousness of their allergy and give them appropriate advice such as whether to carry Epipen, wear a medicalert and learn where and what to avoid. Many of them have cross reactive food allergies that they may not know of, such as to banana, avocado, kiwi, chestnuts etc.
Contact allergy to latex rubber is a chronic Delayed Hypersensitivity reaction and may cause Contact Dermatitis of hands, feet, eyelids etc. As discussed below, we can do patch testing for a wide variety of contact allergens found in latex rubber.
Contact Allergy to Metals, Acrylics and other Dental Materials:
The magic you perform on patient’s smiles often means introduction and installation of metals, acrylics and other compounds into the patient’s mouth. Many of these chemicals directly, or acting as haptens when coupled with body proteins, can induce a Type IV delayed hypersensitivity response. This may lead to contiguous erythema, labial edema, purpuric patches, oral ulcers, gingivitis, angular cheilitis, perioral eczema, buccal Lichen Planus, as well as distant or systemic manifestations such as Palmar and Plantar Dermatoses.
Besides patients, you or your staff who frequently handle these chemicals can develop local (hand) or generalized contact dermatitis due to this type of reaction.
We offer Patch Testing for 150 common contact allergens, 50 of which are commonly used in dentistry that can induce delayed hypersensitivity as per published literature.
In summary, to help you serve your patients better we offer the following services:
Local Anesthetic Allergy Testing
Penicillin Allergy Testing
Patch Testing for Metals, Acrylics and Dental Materials
Latex Allergy Testing
To make an appointment at any of our five convenient locations, please have your staff or the patient call us at 304-343-4300.
We do not need referral from the primary care physician, unless their insurance requires it.
Most Health insurance policies cover the above services as part of regular medical care.
We look forward to serving your patients.