Letter to the Editor
Allergic reaction in the use of primacaine adrenaline

Articaine hydrochloride and adrenaline injection, also known as primacaine adrenaline, is an aqueous solution of 4% adrenaline with 1 : 100,000 adrenaline [1]. Its advantages include fast diffusion through tissues, low dosage, strong local anesthesia efficacy, rapid onset, long duration, being less toxic than lidocaine and avoiding conduction anesthesia complications, like hematoma, infection and nerve injury. It is suitable for local infiltration anesthesia [2] and works quite well clinically in buccal infiltration anesthesia and conduction anesthesia in surgical procedures of osteotomy and mucosal incision [3]. The associated side effects of articaine and adrenaline injection are minor and will disappear after the therapy, and they include neuropathy, nervousness, drowsiness, tremors, anxiety, excessive wordiness, headache, nausea and tinnitus. There have been some reports about allergic reactions caused by administration of articaine and adrenaline injection, of which anaphylaxis is rare. The mechanism of the allergic reaction is still unclear and needs further investigation. Anaphylaxis caused by drugs is the most serious type I hypersensitivity, and may cause death if not treated on time [4, 5].
In this paper, we present a case report of a severe allergic reaction after using the articaine and adrenaline injection, which suggests that close monitoring for allergic reactions is necessary for patients who are first exposed to or specifically susceptible to articaine.
A 65-year-old male patient reported feeling pain in the right upper back tooth for 3 days. The pain occurred at night 3 days before and became more severe over the 3-day period.
The symptom onset appeared 3 days before. The patient felt a sudden sharp pain at intervals in the right upper back tooth when exposed to hot or cold temperature. He took some painkiller orally for relief. The night before seeing the doctor, the pain became intolerable and the oral painkiller relieved the pain only slightly.
The patient had a past medical history of diabetes, hypertension and lumbar disc protrusion. He denied any history of allergy to food or drugs and had no history of administration of anesthesia agents and injuries. He has not taken any medicines recently.
Physical examination revealed a blood pressure of 140/88 mm Hg (1 mm Hg = 0.133 kPa) and pulse of 72 bpm. The patient was conscious and alert. He had a heavy complexion but stable vital signs and responded well to...


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