Patch-test reactions to topical anesthetics: Retrospective analysis of cross-sectional data, 2001 to 2004

Erin M. Warshaw, Sarah E. Schram, Donald V. Belsito, Vincent A. DeLeo, Joseph F. Fowler, Howard I. Maibach, James G. Marks, C. G.Toby Mathias, Melanie D. Pratt, Robert L. Rietschel, Denis Sasseville, Frances J. Storrs, James S. Taylor, Kathryn A. Zug

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


Background: Allergy to topical anesthetics is not uncommon. The cross-reactivity among topical anesthetics and the screening value of benzocaine alone are not well understood. Objectives: The goals for this study were: (1) to evaluate the frequency and pattern of allergic patch-test reactions to topical anesthetics, using North American Contact Dermatitis Group (NACDG) data, and (2) to compare these results to allergen frequencies from other published studies. Methods: The NACDG patch-tested 10,061 patients between 2001 and 2004. In this analysis patients were included who had positive patch-test reactions to one or more of the following: benzocaine, lidocaine, dibucaine, tetracaine, and prilocaine. Results: Of patch-tested patients, 344 (3.4%) had an allergic reaction to at least one anesthetic. Of those, 320 (93.0%) had an allergic reaction to only one topical anesthetic. Overall, reactions to benzocaine (50.0%, 172 of 344) were most prevalent, followed by reactions to dibucaine (27.9%, 96 of 344); however, reactions to dibucaine were significantly more frequent in Canada than in the United States (relative risk [RR], 2.31; 95% confidence interval [CI], 1.67-3.20; p < .0001). Of patients reacting to more than one anesthetic, most (79%, 19 of 24) reacted to both an amide and an ester. Conclusions: Of the topical anesthetics tested, benzocaine was the most frequent allergen overall. Over 50% of allergic reactions to topical anesthetics in this study would have been missed had benzocaine been used as a single screening agent. Cross-reactivity patterns were not consistent with structural groups.

Original languageEnglish (US)
Pages (from-to)81-85
Number of pages5
Issue number2
StatePublished - Mar 2008

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Dermatology


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