the concept of compartment allergy prilocaine injected into different skin layers室的概念过敏丙胺卡因注入不同的皮肤层.pdfVIP

Wobser et al. Allergy, Asthma Clinical Immunology 2011, 7:7 /content/7/1/7 ALLERGY, ASTHMA CLINICAL IMMUNOLOGY CASE REPORT Open Access The concept of “compartment allergy: prilocaine injected into different skin layers * Marion Wobser , Zeno Gaigl and Axel Trautmann 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. Background as the relevant antigenic structure [3]. Delayed-type Local anesthetics (LA) are extensively used drugs with a