DCA02AR Allergic Reactions in Dental Patients _ _________________________________________________
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INTRODUCTION An allergy to any given substance is an abnormal or hypersensi- tive response by the immune system. Approximately 15% to 25% of all Americans have an allergy to at least one substance [1]. Allergic responses can range from watery eyes and conges- tion to life-threatening anaphylaxis. This course will highlight allergic reactions that patients may experience as a result of exposure to medications and materials used during and for dental treatment. The pathophysiologic mechanisms that occur during the varied allergic responses, local and systemic manifestations, and emergency medications and treatment will be discussed. PATIENT ASSESSMENT Before the initiation of any dental treatment, a thorough medi- cal history should be taken. The medical history should not be viewed as a static document; it should be updated regularly and should guide discussions between patients and clinicians. The presence of systemic illness(es), current medications, adverse reactions to medication(s), and any allergic responses warrant further investigation. It is essential to understand that an adverse reaction to a medication is not always an allergic reaction. Adverse drug effects can be categorized as either type A or type B [2]. The most frequent adverse drug reactions (type A) are known pharmacologic effects of a medication. For example, many medications provide warnings about nausea or drowsiness as a potential adverse effect. Although type A reactions are known possibilities, they can be very serious, even life-threatening. In some cases, type A reactions may be incorrectly identified as “allergies,” particularly by patients. Type B adverse drug reactions occur less frequently than their type A counterparts and include allergic reactions. An allergic response occurs when the immune system develops a response to a noninfectious substance (i.e., an antigen). When a patient indicates he or she has had an allergic response to a medication or material, it is important to obtain all of the pertinent details. It may be necessary to contact previous providers to determine the substance that caused the allergic reaction, the extent of systemic involvement, and emergency treatment provided, if applicable. Dental clinicians should not proceed with any dental treatment if there is inadequate information about the patient’s allergy history.
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