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The concept of "compartment allergy": prilocaine injected into different skin layers.

Wobser M, Gaigl Z, Trautmann A - Allergy Asthma Clin Immunol (2011)

Bottom Line: We herein present a patient with delayed-type allergic hypersensitivity against prilocaine leading to spreading eczematous dermatitis after subcutaneous injections for local anesthesia with prilocaine.Prilocaine allergy was proven by positive skin testing and subcutaneous provocation, whereas the evaluation of other local anesthetics - among them lidocaine, articaine and mepivacaine - did not exhibit any evidence for cross-reactivity.Interestingly, our patient repeatedly tolerated strictly deep subcutaneous injection of prilocaine in provocation testing while patch and superficial subcutaneous application mounted strong allergic responses.We hypothesize, that lower DC density in deeper cutaneous compartments and/or different DC subsets exhibiting distinct functional immunomodulatory properties in the various layers of the skin may confer to the observed absence of clinical reactivity against prilocaine after deep subcutaneous injection.The term compartment allergy indicates that the route of allergen administration together with the targeted immunologic environment orchestrates on the immunologic outcome: overt T-cell mediated allergy or clinical tolerance.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Venereology, and Allergology, University of Wuerzburg, Germany. Wobser_M@klinik.uni-wuerzburg.de.

ABSTRACT
We herein present a patient with delayed-type allergic hypersensitivity against prilocaine leading to spreading eczematous dermatitis after subcutaneous injections for local anesthesia with prilocaine. Prilocaine allergy was proven by positive skin testing and subcutaneous provocation, whereas the evaluation of other local anesthetics - among them lidocaine, articaine and mepivacaine - did not exhibit any evidence for cross-reactivity.Interestingly, our patient repeatedly tolerated strictly deep subcutaneous injection of prilocaine in provocation testing while patch and superficial subcutaneous application mounted strong allergic responses. We hypothesize, that lower DC density in deeper cutaneous compartments and/or different DC subsets exhibiting distinct functional immunomodulatory properties in the various layers of the skin may confer to the observed absence of clinical reactivity against prilocaine after deep subcutaneous injection.The term compartment allergy indicates that the route of allergen administration together with the targeted immunologic environment orchestrates on the immunologic outcome: overt T-cell mediated allergy or clinical tolerance.

No MeSH data available.


Related in: MedlinePlus

Clinical findings in delayed-type allergy against local anesthetics and histological picture of skin compartments showing the distribution of S-100 positive dendritic cells. a Delayed-type hypersensitivity reaction 4 days after superficial subcutaneous provocation with prilocaine (1 ml). Inlet Negative result after deep s.c. injection of prilocaine after 4 days. b Differential density of DCs in different skin compartments. Immunohistochemistry with staining of S-100 antigen. Left Overview of the skin layers with declining density of S-100 positive antigen-presenting cells from epidermis to subcutaneous tissue. Magnification 4 ×. Upper right High density of epidermal dendritic cells (Langerhans cells) in epidermis, papillary dermis and reticular dermis. Magnification 40 ×. Lower right In deeper subcutaneous compartments, dermal interstitial S-100 positive DCs are not detectable. Magnification 40 ×.
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Figure 1: Clinical findings in delayed-type allergy against local anesthetics and histological picture of skin compartments showing the distribution of S-100 positive dendritic cells. a Delayed-type hypersensitivity reaction 4 days after superficial subcutaneous provocation with prilocaine (1 ml). Inlet Negative result after deep s.c. injection of prilocaine after 4 days. b Differential density of DCs in different skin compartments. Immunohistochemistry with staining of S-100 antigen. Left Overview of the skin layers with declining density of S-100 positive antigen-presenting cells from epidermis to subcutaneous tissue. Magnification 4 ×. Upper right High density of epidermal dendritic cells (Langerhans cells) in epidermis, papillary dermis and reticular dermis. Magnification 40 ×. Lower right In deeper subcutaneous compartments, dermal interstitial S-100 positive DCs are not detectable. Magnification 40 ×.

Mentions: Incremental inflammatory reactions after 1-4 days were provoked by superficial subcutaneous injection of prilocaine (Figure 1a), so that diagnosis of delayed-type allergy against prilocaine without cross-reactivity against other local anesthetics of different substance groups was made. To note, provocation testing with articaine remained negative over 4 days.


The concept of "compartment allergy": prilocaine injected into different skin layers.

Wobser M, Gaigl Z, Trautmann A - Allergy Asthma Clin Immunol (2011)

Clinical findings in delayed-type allergy against local anesthetics and histological picture of skin compartments showing the distribution of S-100 positive dendritic cells. a Delayed-type hypersensitivity reaction 4 days after superficial subcutaneous provocation with prilocaine (1 ml). Inlet Negative result after deep s.c. injection of prilocaine after 4 days. b Differential density of DCs in different skin compartments. Immunohistochemistry with staining of S-100 antigen. Left Overview of the skin layers with declining density of S-100 positive antigen-presenting cells from epidermis to subcutaneous tissue. Magnification 4 ×. Upper right High density of epidermal dendritic cells (Langerhans cells) in epidermis, papillary dermis and reticular dermis. Magnification 40 ×. Lower right In deeper subcutaneous compartments, dermal interstitial S-100 positive DCs are not detectable. Magnification 40 ×.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104479&req=5

Figure 1: Clinical findings in delayed-type allergy against local anesthetics and histological picture of skin compartments showing the distribution of S-100 positive dendritic cells. a Delayed-type hypersensitivity reaction 4 days after superficial subcutaneous provocation with prilocaine (1 ml). Inlet Negative result after deep s.c. injection of prilocaine after 4 days. b Differential density of DCs in different skin compartments. Immunohistochemistry with staining of S-100 antigen. Left Overview of the skin layers with declining density of S-100 positive antigen-presenting cells from epidermis to subcutaneous tissue. Magnification 4 ×. Upper right High density of epidermal dendritic cells (Langerhans cells) in epidermis, papillary dermis and reticular dermis. Magnification 40 ×. Lower right In deeper subcutaneous compartments, dermal interstitial S-100 positive DCs are not detectable. Magnification 40 ×.
Mentions: Incremental inflammatory reactions after 1-4 days were provoked by superficial subcutaneous injection of prilocaine (Figure 1a), so that diagnosis of delayed-type allergy against prilocaine without cross-reactivity against other local anesthetics of different substance groups was made. To note, provocation testing with articaine remained negative over 4 days.

Bottom Line: We herein present a patient with delayed-type allergic hypersensitivity against prilocaine leading to spreading eczematous dermatitis after subcutaneous injections for local anesthesia with prilocaine.Prilocaine allergy was proven by positive skin testing and subcutaneous provocation, whereas the evaluation of other local anesthetics - among them lidocaine, articaine and mepivacaine - did not exhibit any evidence for cross-reactivity.Interestingly, our patient repeatedly tolerated strictly deep subcutaneous injection of prilocaine in provocation testing while patch and superficial subcutaneous application mounted strong allergic responses.We hypothesize, that lower DC density in deeper cutaneous compartments and/or different DC subsets exhibiting distinct functional immunomodulatory properties in the various layers of the skin may confer to the observed absence of clinical reactivity against prilocaine after deep subcutaneous injection.The term compartment allergy indicates that the route of allergen administration together with the targeted immunologic environment orchestrates on the immunologic outcome: overt T-cell mediated allergy or clinical tolerance.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Venereology, and Allergology, University of Wuerzburg, Germany. Wobser_M@klinik.uni-wuerzburg.de.

ABSTRACT
We herein present a patient with delayed-type allergic hypersensitivity against prilocaine leading to spreading eczematous dermatitis after subcutaneous injections for local anesthesia with prilocaine. Prilocaine allergy was proven by positive skin testing and subcutaneous provocation, whereas the evaluation of other local anesthetics - among them lidocaine, articaine and mepivacaine - did not exhibit any evidence for cross-reactivity.Interestingly, our patient repeatedly tolerated strictly deep subcutaneous injection of prilocaine in provocation testing while patch and superficial subcutaneous application mounted strong allergic responses. We hypothesize, that lower DC density in deeper cutaneous compartments and/or different DC subsets exhibiting distinct functional immunomodulatory properties in the various layers of the skin may confer to the observed absence of clinical reactivity against prilocaine after deep subcutaneous injection.The term compartment allergy indicates that the route of allergen administration together with the targeted immunologic environment orchestrates on the immunologic outcome: overt T-cell mediated allergy or clinical tolerance.

No MeSH data available.


Related in: MedlinePlus