What precautions should be taken if the patient is allergic to povidone iodine lidocaine or latex?
• Patients with topical iodine reactions can have their skin cleansed with chlorhexidine or pHisoHex followed by an alcohol pad.
• True “caine” allergy is extremely rare. Many of the symptoms that occur during dental procedures are due to the epinephrine or preservatives (parabens) in the lidocaine (Xylocaine) and not an IgE-mediated reaction. To be absolutely sure, skin testing and subcutaneous incremental challenge would have to be done. This is usually not practical; therefore, options include numbing the area with a skin refrigerant (ethyl chloride) only or using a local anesthetic from the benzoic acid ester group that does not cross-react with lidocaine such as chloroprocaine (Nesacaine). Note that a patient with a procaine (Novocain) reaction can use lidocaine (Xylocaine).
• Most latex allergies are minor local reactions. However, some patients can have a severe latex allergy. In these patients, arthrocentesis must be performed using latex-free gloves and syringes. The rubber stopper on the top of the lidocaine must be removed because sticking a needle through this can result in latex protein being introduced into the lidocaine.