What guidance do you provide to patients with history concerning for IgE-mediated reaction to local anesthetic, such as lidocaine?

In addition to skin testing, what next steps would you offer patients when history is highly concerning for IgE-mediated reaction such as immediate hives and/or flushing +/- respiratory or cardiovascular symptoms?

• Avoid all local anesthetics
• SPT to lidocaine only. Give clearance for all other amide and all ester local anesthetics
• SPT to all amide local anesthetics. Give clearance for all ester local anesthetics
• SPT to all amide and ester local anesthetics
• Other