Abstract
BACKGROUND: Local anesthetics (LAs) are widely used, but true immune-mediated allergies are rare. Most adverse events are toxic or autonomic, yet patients are frequently mislabeled as allergic. This study aims to determine the prevalence of allergy evaluation and testing following suspected reactions to LAs. METHODS: A cross-sectional retrospective study was conducted with a total of 126 patients. The study collected medical records from tertiary care hospitals in Saudi Arabia from 2016 to 2022, analyzing patients with reported allergic reactions to LA. The analysis included demographics, occurrences, medical procedure type, and allergy testing history. RESULTS: Lidocaine was the most common agent, involved in over 90% of cases. Reactions primarily followed injections, with symptoms ranging from rash and itching to anaphylactic shock. Despite these events, only 10 patients (7.94%) were referred for further investigation. Allergy testing was performed in only three patients (2.38%). Among those tested, one was negative, while two tested positive (one for lidocaine and one for a lidocaine-bupivacaine combination). CONCLUSION: The study highlights a low prevalence of follow-up allergy testing despite reported adverse reactions. Systematic testing is essential to confirm or rule out true LA allergies, ensuring patient safety and identifying viable anesthetic alternatives for future procedures.