Clinical Application of BAT (Basophil Activation Test) for Local Anesthetics

Abstract

  Allergic reactions following local anesthesia can be lethal during dental practice. Although true allergies against local anesthetics are rare, a precise diagnosis is critical. In situ tests, such as skin tests, can be risky if they evoke real allergic reactions. The basophil activation test (BAT) is expected to be a reliable and safe in vitro test for detecting the activation of basophils. We used the BAT in 9 patients who visited Showa University Dental Hospital and were suspected of having allergies to local anesthetics. These patients had previously experienced the following allergic symptoms : loss of consciousness, 33.3% ; redness, 33.3% ; nausea, 11.1% ; wheezing, 22.2% ; dizziness, 22.2% ; and palpitations, 11.1%. One patient had tested positive to a xylocaine challenge test. The suspected local anesthetics were unknown (n=4), xylocaine preparations (n=3), and the ORA^® Injection Dental Cartridge (n=3). All the BAT results were negative. Eight of the 9 patients underwent dental treatment using local anesthetics under careful observation. None of the patients showed any symptoms suggestive of an allergy. We failed to confirm BAT positivity in patients suspected of having an allergy to local anesthetics. Although the patients had experienced an episode leading to the suspicion of an allergic reaction, true reproducible allergies could not be confirmed. Since the sensitivity and specificity of the BAT for detecting allergies to local anesthetics have not been determined, the present results cannot be used to determine whether the BAT is a reliable means of testing for allergies to local anesthetics. Further study is needed.