Management of Anaphylaxis in the Dental Practice: an Update

Overview

Journal Br Dent J

Specialty Dentistry

Date 2020 Dec 14

PMID 33311677

Citations 3

Authors

Phil Jevon

Shaam Shamsi

Affiliations

Soon will be listed here.

Abstract

Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur in the dental practice. There are a number of dental-related causes including mouthwashes, local anaesthetics, latex and antibiotics. The dental team must be able to respond effectively and manage the life-threatening situation appropriately following Resuscitation Council UK guidelines. The timely administration of adrenaline is life-saving; any delays can lead to a poor outcome. With the current national supply issues with adrenaline auto-injector devices, there is an expectation that GDPs should be competent at drawing up adrenaline from an ampoule and administrating it intramuscularly. The aim of this article is to provide an update on the management of anaphylaxis in the dental practice with particular reference to the procedure for intramuscular injection of adrenaline.

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References

Paiva M, Piedade S, Gaspar A . Toothpaste-induced anaphylaxis caused by mint (Mentha) allergy. Allergy. 2010; 65(9):1201-2. DOI: 10.1111/j.1398-9995.2010.02329.x. View

Baluga J, Casamayou R, Carozzi E, Lopez N, Anale R, Borges R . Allergy to local anaesthetics in dentistry. Myth or reality?. Allergol Immunopathol (Madr). 2002; 30(1):14-9. DOI: 10.1016/s0301-0546(02)79081-2. View

Soar J, Pumphrey R, Cant A, Clarke S, Corbett A, Dawson P . Emergency treatment of anaphylactic reactions--guidelines for healthcare providers. Resuscitation. 2008; 77(2):157-69. DOI: 10.1016/j.resuscitation.2008.02.001. View

Harper N, Dixon T, Dugue P, Edgar D, Fay A, Gooi H . Suspected anaphylactic reactions associated with anaesthesia. Anaesthesia. 2009; 64(2):199-211. PMC: 3082210. DOI: 10.1111/j.1365-2044.2008.05733.x. View

Becker D . Drug allergies and implications for dental practice. Anesth Prog. 2014; 60(4):188-97. PMC: 3891459. DOI: 10.2344/0003-3006-60.4.188. View

Song T, Lieberman P . Epinephrine in anaphylaxis: doubt no more. Curr Opin Allergy Clin Immunol. 2015; 15(4):323-8. DOI: 10.1097/ACI.0000000000000185. View

Weenig C . A better, safer, and inexpensive way to open glass ampules. Anesthesiology. 1998; 88(3):838. DOI: 10.1097/00000542-199803000-00046. View

Ewan P, Brathwaite N, Leech S, Luyt D, Powell R, Till S . Prescribing an adrenaline auto-injector - personalized care recommended. Clin Exp Allergy. 2016; 46(12):1621-1622. DOI: 10.1111/cea.12855. View

Henderson S . Allergy to local anaesthetic agents used in dentistry--what are the signs, symptoms, alternative diagnoses and management options?. Dent Update. 2011; 38(6):410-2. DOI: 10.12968/denu.2011.38.6.410. View

10.

Hamann C, Turjanmaa K, Rietschel R, SIEW C, Owensby D, Gruninger S . Natural rubber latex hypersensitivity: incidence and prevalence of type I allergy in the dental professional. J Am Dent Assoc. 1998; 129(1):43-54. DOI: 10.14219/jada.archive.1998.0021. View

11.

Roth J, Shields A . A dilemma: How does one treat anaphylaxis in the sulfite allergic patient since epinephrine contains sodium metabisulfite?. Anesth Analg. 2004; 98(5):1499. DOI: 10.1213/01.ane.0000120092.39021.f2. View

12.

Lee J, Lee J, Kim H, Seo K . Dental anesthesia for patients with allergic reactions to lidocaine: two case reports. J Dent Anesth Pain Med. 2017; 16(3):209-212. PMC: 5586559. DOI: 10.17245/jdapm.2016.16.3.209. View

13.

Batinac T, Sotosek Tokmadzic V, Peharda V, Brajac I . Adverse reactions and alleged allergy to local anesthetics: analysis of 331 patients. J Dermatol. 2013; 40(7):522-7. DOI: 10.1111/1346-8138.12168. View

14.

Storey P, Fitzharris P . Adrenaline in anaphylaxis: overtreatment in theory, undertreatment in reality. Postgrad Med J. 2015; 91(1071):1-2. DOI: 10.1136/postgradmedj-2014-133185. View

15.

Song T, Nelson M, Chang J, Engler R, Chowdhury B . Adequacy of the epinephrine autoinjector needle length in delivering epinephrine to the intramuscular tissues. Ann Allergy Asthma Immunol. 2005; 94(5):539-42. DOI: 10.1016/S1081-1206(10)61130-1. View

16.

Harper N, Cook T, Garcez T, Farmer L, Floss K, Marinho S . Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Br J Anaesth. 2018; 121(1):159-171. DOI: 10.1016/j.bja.2018.04.014. View

17.

Maher N, de Looze J, Hoffman G . Anaphylaxis: an update for dental practitioners. Aust Dent J. 2014; 59(2):142-8. DOI: 10.1111/adj.12161. View

18.

Pumphrey R . Fatal posture in anaphylactic shock. J Allergy Clin Immunol. 2003; 112(2):451-2. DOI: 10.1067/mai.2003.1614. View

19.

Greenway K . Rituals in nursing: intramuscular injections. J Clin Nurs. 2014; 23(23-24):3583-8. DOI: 10.1111/jocn.12627. View

20.

Fisher M, Bowey C . Alleged allergy to local anaesthetics. Anaesth Intensive Care. 1998; 25(6):611-4. DOI: 10.1177/0310057X9702500602. View