What are the main uses of sodium chloride in medical settings. How is sodium chloride administered for various conditions. What are the potential side effects and precautions associated with sodium chloride use. When should you contact a healthcare provider while using sodium chloride products.

Understanding Sodium Chloride and Its Medical Applications

Sodium chloride, commonly known as salt, plays a crucial role in various medical applications. Its versatility makes it an essential component in healthcare settings. This comprehensive guide explores the diverse uses, administration methods, potential side effects, and precautions associated with sodium chloride products.

The Many Forms and Uses of Sodium Chloride in Medicine

Sodium chloride is available in multiple forms, each tailored for specific medical purposes:

• Injections and tablets
• Nasal sprays and drops
• Eye solutions
• Skin cleansers
• Nebulizer solutions
• IV flushes

These various forms allow healthcare providers to address a wide range of medical conditions and needs.

Treating Low Sodium Levels and Fluid Loss

One of the primary uses of sodium chloride injections and tablets is to address hyponatremia, a condition characterized by low sodium levels in the blood. How does sodium chloride help in this situation? By replenishing the body’s sodium stores, it helps restore the proper balance of electrolytes, which is crucial for various bodily functions.

In cases of severe fluid loss, such as dehydration, sodium chloride injections can be administered to help rehydrate the body and maintain proper fluid balance.

Nasal Care and Respiratory Support

Sodium chloride solutions play a vital role in maintaining nasal health and supporting respiratory function:

• Nasal sprays and drops help moisturize dry or irritated nasal passages
• Saline solutions thin mucus, making it easier to expel through coughing
• Nebulizer solutions can be mixed with other medications for inhalation therapy

Wound Care and Skin Cleansing

Sodium chloride solutions are widely used in wound care. Why are they effective for this purpose? The isotonic nature of saline solutions makes them gentle on tissues while effectively cleansing wounds and removing debris. This helps promote proper healing and reduces the risk of infection.

Administration Methods and Precautions

The administration of sodium chloride varies depending on its form and intended use:

• Injections are typically administered by healthcare professionals
• Tablets are taken orally as prescribed
• Nasal sprays and drops are applied directly to the nasal passages
• Eye solutions are administered as directed for specific ocular conditions
• Skin cleansers are applied topically to wounds or affected areas

Regardless of the administration method, it’s crucial to follow the prescribed dosage and instructions provided by your healthcare provider.

Potential Side Effects and Adverse Reactions

While sodium chloride is generally well-tolerated, some individuals may experience side effects or adverse reactions. These can range from mild discomfort to more severe complications:

Common Side Effects

• Nausea or upset stomach
• Headache
• Dizziness
• Irritation at the injection site (for injectable forms)

Serious Adverse Reactions

In rare cases, more severe reactions may occur. These require immediate medical attention:

• Signs of an allergic reaction (rash, hives, difficulty breathing, swelling of face or throat)
• Electrolyte imbalances (confusion, muscle cramps, irregular heartbeat)
• Severe swelling in arms or legs
• Chest pain or shortness of breath

Can sodium chloride cause allergic reactions? While rare, some individuals may be sensitive to sodium chloride or other components in the formulation. It’s essential to report any unusual symptoms to your healthcare provider promptly.

Important Precautions and Considerations

Before using sodium chloride products, it’s crucial to consider the following precautions:

• Inform your healthcare provider of any allergies or sensitivities
• Disclose all medications and supplements you’re currently taking
• Discuss any existing medical conditions, especially kidney problems or fluid retention issues
• If pregnant or breastfeeding, consult your doctor about the potential risks and benefits

For individuals on low-sodium diets, is it safe to use sodium chloride products? It’s essential to consult with your healthcare provider, as they can advise on whether the benefits outweigh any potential risks in your specific situation.

Monitoring and Follow-up Care

When using sodium chloride products, especially for treating low sodium levels or fluid imbalances, regular monitoring is essential. This may include:

• Blood tests to check electrolyte levels
• Regular check-ups to assess overall health and treatment efficacy
• Monitoring for any signs of fluid retention or electrolyte imbalances

How often should blood work be done when using sodium chloride for medical purposes? The frequency of blood tests will depend on your specific condition and treatment plan. Your healthcare provider will determine the appropriate schedule for monitoring your progress.

Special Considerations for Different Formulations

Different forms of sodium chloride may have specific considerations:

Injections

Long-term use of sodium chloride injections may pose a risk of aluminum toxicity, especially in individuals with kidney problems or premature infants. Healthcare providers will carefully monitor patients to mitigate this risk.

Eye Products

When using sodium chloride eye solutions, exercise caution while driving or performing tasks that require clear vision. These products may temporarily affect visual acuity.

Nasal Products

While generally safe for regular use, prolonged use of nasal sprays may lead to rebound congestion in some individuals. It’s essential to follow the recommended usage guidelines.

Sodium chloride plays a vital role in various medical applications, from treating electrolyte imbalances to supporting wound care and respiratory health. By understanding its uses, potential side effects, and necessary precautions, patients can work closely with their healthcare providers to ensure safe and effective use of sodium chloride products. Always consult with a medical professional for personalized advice and guidance on using sodium chloride for your specific health needs.

Sodium Chloride | Memorial Sloan Kettering Cancer Center

Adult Medication

This information from Lexicomp^® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

4-Way Saline [OTC]; Afrin Saline Nasal Mist [OTC]; Altachlore [OTC]; Altamist Spray [OTC]; Atrapro Dermal Spray; Ayr Nasal Mist Allergy/Sinus [OTC]; Ayr Saline Nasal Drops [OTC]; Ayr Saline Nasal Gel [OTC]; Ayr Saline Nasal Neti Rinse [OTC]; Ayr Saline Nasal No-Drip [OTC]; AYR Saline Nasal Rinse [OTC]; Ayr Saline Nasal [OTC]; Ayr [OTC]; Baby Ayr Saline [OTC]; Deep Sea Nasal Spray [OTC]; DiaB Klenz [OTC] [DSC]; Entsol Nasal [OTC] [DSC]; HyperSal; Liquivida Hydration [DSC]; MicroKlenz Wound Cleanser [OTC] [DSC]; Muro 128 [OTC]; Nasal Moist [OTC]; Nebusal; Ocean Complete Sinus Rinse [OTC]; Ocean for Kids [OTC]; Ocean Nasal Spray [OTC]; Ocean Ultra Saline Mist [OTC]; Pretz Irrigation [OTC]; Pretz Natur Moist Nasal Spray [OTC]; Pretz [OTC]; PulmoSal; RadiaKlenz [OTC] [DSC]; Remedy 4-in-1 Body Cleanser [OTC] [DSC]; Rhinaris [OTC] [DSC]; Safe Wash [OTC]; Saline Flush ZR [DSC]; Saline Mist Spray [OTC]; Saljet Rinse [OTC]; Saljet [OTC]; Sochlor [OTC] [DSC]; SwabFlush Saline Flush [DSC]; Ultra-Klenz [OTC]; Wound Wash Saline [OTC]

Brand Names: Canada

Addipak Sodium Chloride; Aquapak; Ballard Unit Dose

What is this drug used for?

Injection and tablet:

• It is used to treat low sodium levels.

Injection:

• It is used to treat fluid loss.
• It is used to mix with a drug that is given as a shot.

Flush:

• It is used to flush IV sets and access devices.

Liquid for breathing in:

• It is used to thin mucus so it can be taken from the body by coughing.
• It is used to mix with other drugs for use in a special machine (nebulizer).

All nose products:

• It is used to treat dry or irritated nose passages.
• It is used to thin fluid in the nose passages.

All skin products:

• It is used to clean wounds.

For use in the eye:

• It is used to lower swelling.

All products:

• It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take this drug?

All products:

• If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.

Injection and tablet:

• If you have high sodium levels or swelling.

This is not a list of all drugs or health problems that interact with this drug.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take this drug?

All products:

• Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
• Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.

Injection and tablet:

• If you are on a low-salt or salt-free diet, talk with your doctor.
• Have blood work checked as you have been told by the doctor. Talk with the doctor.

Injection:

• This drug may contain aluminum. There is a chance of aluminum toxicity if you are on this drug for a long time. The risk is greater if you have kidney problems. The risk is also higher in premature infants. Talk with the doctor.

All eye products:

• Use care when driving or doing other tasks that call for clear eyesight.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

All products:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Injection and tablet:

• Signs of electrolyte problems like mood changes; confusion; muscle pain, cramps, or spasms; weakness; shakiness; change in balance; an abnormal heartbeat; seizures; loss of appetite; or severe upset stomach or throwing up.
• Shortness of breath, a big weight gain, or swelling in the arms or legs.

Injection:

• Very bad dizziness or passing out.
• Fever or chills.
• Shakiness.
• Chest pain or pressure or a fast heartbeat.
• Flushing.
• Burning, stinging, or redness where this drug goes into the body.
• Pain and irritation where this drug goes into the body.

All eye products:

• Change in eyesight, eye pain, or severe eye irritation.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

All eye products:

• Burning.
• Eye irritation.

Tablets:

• Upset stomach or throwing up.

All nose products:

• Nose irritation.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to your national health agency.

You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.

How is this drug best taken?

Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.

Tablets:

• Take tablets with or without food. Take with food if it causes an upset stomach.
• You may dissolve the tablet in water and drink.

Injection:

• It is given as an infusion into a vein over a period of time.

Liquid for breathing in:

• You will use by breathing in from the mouth with a special machine (nebulizer). Your doctor will teach you the right way to use.

All nose products:

• Do not take this drug by mouth. Use in your nose only. Keep out of your mouth and eyes (may burn).

All skin products:

• Wash your hands before and after use. If your hand is the treated area, do not wash your hand after use.
• Clean affected part before use. Make sure to dry well.

All eye products:

• For the eye only.
• Wash your hands before and after use.
• Take out contact lenses before using this drug. Lenses may be put back in 15 minutes after this drug is given. Do not put contacts back in if your eyes are irritated or infected.
• Do not touch the container tip to the eye, lid, or other skin. This could lead to bacteria in the drug, which may cause severe eye problems or loss of eyesight.

Eye drops:

• Tilt your head back and drop drug into the eye.
• Gently press the skin under the lower eyelid and pull the lower eyelid away from the eye slightly until you can see a small pouch.
• After use, keep your eyes closed. Put pressure on the inside corner of the eye. Do this for 1 to 2 minutes. This keeps the drug in your eye.
• Do not use if the solution is cloudy, leaking, or has particles.
• Do not use if solution changes color.

Eye ointment:

• Gently pull down the lower lid and squeeze in how much the doctor told you to use.
• Let go of the lower eyelid and keep eyes closed for 1 to 2 minutes.

What do I do if I miss a dose?

Injection and flush:

• Call your doctor to find out what to do.

All other products:

• If you use this drug on a regular basis, use a missed dose as soon as you think about it.
• If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
• Do not take 2 doses at the same time or extra doses.
• Many times this drug is used on an as needed basis. Do not use more often than told by the doctor.

How do I store and/or throw out this drug?

Injection and flush:

• If you need to store this drug at home, talk with your doctor, nurse, or pharmacist about how to store it.

All other products:

• Store at room temperature in a dry place. Do not store in a bathroom.
• Protect from heat.

All products:

• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else’s drugs.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider’s examination and assessment of a patient’s specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

Last Reviewed Date

2021-07-09

Copyright

© 2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

Last Updated

Monday, December 12, 2022

Elevated salt concentrations in affected skin — ScienceDaily

Salt apparently affects allergic immune reactions. A team working with Prof. Christina Zielinski at the Technical University of Munich (TUM) has demonstrated in cell cultures that salt leads to the formation of Th3 cells. These immune cells are active in allergic conditions such as atopic dermatitis. The team also detected elevated salt concentrations in the skin of patients.

In industrial countries, nearly one in three people are affected by allergies at some point in their lives. One in ten children suffer from atopic dermatitis. T-cells play an important role in immune conditions of this kind. They are a vital aspect of the body’s resistance to infections, but, if uncontrolled, can also develop pathological responses and start attacking parts of our bodies or innocuous substances such as allergens.

When such functions occur, Th3 cells, a subgroup of T cells, can cause inflammatory skin conditions such as atopic dermatitis. This involves increased production of the proteins interleukin 4 (IL-4) and interleukin 13 (IL-13). It is still unknown what triggers the signalling malfunction.

More Th3 cells under the influence of sodium ions

Table salt, known scientifically as sodium chloride, is essential to the health of humans and animals. In the body it occurs in the form of sodium and chlorine ions. In a recent study, Christina Zielinski, a DZIF-professor at TUM’s Institute of Virology, and her team were able to demonstrate that sodium chloride can induce a state in human T cells that causes them to produce increased amounts of the proteins IL-4 and IL-13.

Types of T-cells, which should not cause allergies, can, in the presence of salt, turn into Th3 cells. The changes are reversed when the T cell is again exposed to lower salt levels. “Consequently, ionic signals do play a role in the generation and control of Th3 cells,” says Christina Zielinski.

Highly elevated salt levels in the skin of patients suffering from atopic dermatitis

As a medical specialist in the field of dermatology, Zielinski is naturally interested in atopic dermatitis. Her team investigated whether the affected skin regions of atopic dermatitis patients exhibit elevated sodium levels.” Measuring sodium concentrations in the tissue is complicated,” explains the first author of the study, Julia Matthias. “Dissolved salt in blood can be measured using standard clinical methods. But for the skin, we needed the help of colleagues in nuclear chemistry and physics.” They tested the skin samples at the Research Neutron Source Heinz Maier-Leibnitz (FRM II) at TUM and at the Institute for Nuclear Chemistry at the University of Mainz by means of neutron activation analysis. The sodium levels in the affected skin areas of patients suffering from atopic dermatitis proved to be up to 30 times higher than in healthy skin.

Ideal conditions for bacteria thriving under salty conditions

“The higher sodium levels in the affected skin neatly match another characteristic of atopic dermatitis,” says Christina Zielinski. “It has been known for some time that patients with this condition have elevated levels of the bacterium Staphylococcus aureus on their skin. These are bacteria, which thrive under salty conditions — in contrast to other commensal bacteria, which are in fact harmed by salt. ” Zielinski believes that this insight along with others and the current research results point to a link between salt and the occurrence of atopic dermatitis.

“However, we have not yet been able to show how these large quantities of salt find their way to the skin,” she concedes. “For that reason, we are also unsure of how a low-salt or high-salt diet might be related to the appearance and progression of atopic dermatitis or other allergic conditions.” Professor Zielinski and her team hope to answer these and other questions in future interdisciplinary studies.

Drug allergy: symptoms and causes

The article was checked by a doctor: Lozko Natalia Ivanovna

Types of drug allergy

The penetration of a problematic drug into the body provokes one of the types of an allergic reaction:

• Reaction of immediate type. It develops within a few seconds to one hour after the administration of the drug. Repeated contact with a problem drug causes an inflammatory process in the tissues or throughout the body.

• Delayed reaction. It occurs 24-48 hours after the introduction of the allergen.

• cytotoxic reaction. Drugs are attached to the cells of blood vessels, liver and kidneys, blood elements. This leads to damage to these organs, the occurrence of anemia (hemoglobin deficiency), leukopenia (decrease in white blood cells). The response time is minutes or hours.

• immunocomplex reaction. Medicinal substances attach to the walls of blood vessels, increased vascular permeability develops, serum sickness, arthritis, drug fever, allergic vasculitis (inflammation of the vascular walls).

• Pseudoallergic reaction. Occurs without the formation of antibodies. A false allergic reaction is exacerbated by chronic diseases of the gastrointestinal tract, endocrine pathologies. The intensity of clinical manifestations and the rate of occurrence of the reaction depends on the dosage and route of administration of the drug.

The same medicine can provoke both a true allergy and a pseudo-allergic reaction.

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+7 (495) 215-56-90

Make an appointment with an allergist

Causes of drug allergy

Any drug can cause an allergic reaction. Once in the body and in contact with tissues, they provoke allergic reactions. The exception is glucose, sodium chloride.

The drugs that most often cause allergic reactions include:

• analgesics,

• local and systemic anesthetics,

• antibiotics,

• protein preparations,

• glucocorticosteroids,

• serum,

• non-steroidal anti-inflammatory drugs,

• immunological agents,

• vitamin complexes,

• vaccines.

The rate of development of an allergic reaction depends on the route of administration of the drug. Most often and quickly cause allergies local and inhalation application. Intravenous administration with a lower frequency provokes hypersensitivity than intramuscular and subcutaneous. With parenteral administration of drugs (droppers), allergies occur less frequently than with oral administration (by mouth).

There are a number of factors that increase the risk of allergies:

• genetic predisposition,

• congenital and acquired immunodeficiencies,

• cytomegalovirus infection,

• bronchial asthma,

• gouty arthritis.

The severity of drug allergy depends on the duration of use of the drug, the dosage, the duration of the intervals between its intake. A single injection is less likely to cause allergies than long-term use.

Help! The presence of drug intolerance in one of the parents increases the risk of allergies in a child by 15 times.

Symptoms of drug allergy

Get expert advice:

• Allergist
• Allergist for children

Clinical manifestations of allergy are diverse and depend on the drug administered, the reactivity of the immune system and the presence of comorbidities. Most often, the skin, blood vessels and respiratory tract are affected. Reactions are local and systemic.

Local skin changes are manifested by a rash, redness of the skin, the formation of single or multiple blisters, erosions, plaques. Drug allergy to antibacterial drugs provokes multimorphic exudative erythema. Its symptoms are joint and muscle pain, fever, rashes on the skin of the feet, hands, palms and soles.

Due to hypersensitivity to antibacterial drugs, changes in the respiratory system are observed:

• bronchospasm,

• difficult nasal breathing

• nasal discharge,

• lacrimation,

• decreased or absent sense of smell,

• itching in the nasal cavity.

Less commonly, the only sign of an allergy may be general malaise, weakness, fever, nausea, and vomiting.

Drug allergy to the injection of the drug manifests itself in the form of the Arthus Phenomenon. This is when, after 7–10 days from the moment the allergen enters the body, a red spot and swelling form around the injection site. With a small dose of the drug, the edema disappears on its own. In a severe case, skin necrosis occurs with the formation of a long-term non-healing ulcer.

Systemic allergic reactions include:

• anaphylactic shock – an acute condition in which hypoxia develops, a decrease in blood flow;

• Stevens-Johnson syndrome – the formation of blisters on the skin and mucous membranes of the whole body;

• acute kidney injury;

• disruption of the nervous, respiratory and cardiovascular systems;

• rheumatic pathologies;

• erosive and ulcerative defects on the mucosa of the gastrointestinal tract;

• systemic vasculitis – inflammation of the vascular walls.

The development of systemic reactions requires urgent medical attention, otherwise there is a high risk of death.

Diagnosis of drug allergy

To diagnose drug allergies, it is important to take a history, find out which drug the patient took before the allergic reaction, for how long and in what dosage. To establish a diagnosis, you will need to consult an allergist-immunologist, dermatologist or infectious disease specialist, if necessary, a nephrologist, rheumatologist, cardiologist.

The doctor carefully collects information about previously transferred pathologies, conducts a clinical examination and finds out the features of the clinical picture. During the examination, he assesses the general condition of the patient, the safety of the functions of the respiratory and cardiovascular systems, and detects local changes on the skin.

The most informative method for diagnosing drug allergies is allergological tests. To determine the hypersensitivity of the body, the alleged allergen is injected intradermally or applied to the skin in standard concentrations. In the presence of hypersensitivity to the allergen, a local allergic reaction will appear at the injection site in the form of a rash, itching, redness and swelling.

It is important to distinguish allergy from intoxication after taking high doses of the drug, other allergic and pseudo-allergic reactions, infectious diseases (measles, scarlet fever).

Treatment of drug allergy

First of all, it is necessary to stop the introduction of the problem medication and create conditions for its speedy removal from the body. Taking into account the symptoms and the general condition of the patient, glucocorticosteroids, antiallergic drugs, infusion therapy (introduction of various solutions into the bloodstream), support the functions of respiration and circulation. If it is impossible to completely abandon the problem drug, allergen-specific immunotherapy (ASIT) is performed. Systemic allergic reactions require hospitalization.

Antihistamines

Anti-allergic drugs go on sale in different dosage forms: the bulk are tablets, dragees, capsules for oral administration. In addition to them, external agents are used on the skin, local preparations (eye and nasal drops, sprays).

Antihistamines have a wide range of actions:

• facilitate the course of allergic reactions,

• eliminate spasm of smooth muscles,

• reduce bronchial hyperactivity,

• reduce capillary permeability

• neutralize puffiness.

Antihistamines should be taken only as prescribed by a doctor, as they have contraindications: pregnancy, breastfeeding, childhood, severe renal failure, individual intolerance to the components of the composition. The average duration of treatment is 2-6 weeks.

Help! New generation antihistamines are the most effective, as they have high anti-allergic efficacy along with the absence or minimal risk of side effects.

Glucocorticosteroids

Hormonal preparations, entering the body, inhibit inflammatory processes, eliminate the symptoms of allergic reactions. To achieve the maximum effect, prolonged therapy is required for several weeks. In bronchial asthma and according to indications, hormones are administered using an inhaler.

Glucocorticosteroids in combination with antihistamines have a more pronounced effect than monotherapy. Take with caution in viral, bacterial and fungal infections.

Infusion therapy

To reduce the amount of toxic substances in the blood, to normalize the acid-base balance, solutions of mineral salts and organic acids, glucose are administered intravenously. In parallel, enterosorbents and laxatives are taken inside. It is recommended to observe the drinking regimen.

Allergen-Specific Immunotherapy (ASIT)

To date, this is the most effective method of treating and preventing drug allergies when it is impossible to stop using the problematic drug. The method is based on the introduction into the body of the causative agent of an allergic reaction in gradually increasing doses. This leads to the fact that the body adapts to the action of the causative allergen, sensitivity decreases, clinical manifestations decrease or do not occur at all.

Important! Specific immunotherapy is not given to children under 5 years of age.

The allergen is introduced into the body in different ways in two stages: the initial stage is a dose set, the second is maintenance therapy. The course of treatment lasts from several months to several years.

The prognosis of drug allergy is favorable. By following the recommendations of the doctor, the likelihood of complications is minimized.

Prevention of drug allergy

Preventive measures are aimed at conducting explanatory work among the population about the possible consequences of self-prescription and unsystematic use of drugs. To prevent unwanted allergic reactions, the doctor should carefully take an anamnesis before prescribing or administering any medication.

In the future, the patient must exclude the problematic drug and medicines with a similar genetic part of the antigen. When contacting other medical institutions, report the presence of intolerance to these drugs.

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Manifestations of allergic reactions that occur at a dental appointment

Manifestations of allergic reactions that occur at a dental appointment

Website of the publishing house “Media Sfera”
contains materials intended exclusively for healthcare professionals. By closing this message, you confirm that you are a registered medical professional or student of a medical educational institution.

Sabantseva E.G.

Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia

Ivanova E. V.

Federal State Budgetary Institution of Science Institute of Cellular and Intracellular Symbiosis of the Ural Branch of the Russian Academy of Sciences

Rabinovich I.M.

Federal State Budgetary Institution National Medical Research Center “Central Research Institute of Dentistry and Maxillofacial Surgery” of the Ministry of Health of Russia

Manifestations of allergic reactions that occur at a dental appointment

Authors:

Sabantseva E.G., Ivanova E.V., Rabinovich I.M.

More about the authors

Journal:

Dentistry.

2021;100(6‑2): 29‑32

DOI:

10.17116/stomat202110006229

How to quote:

Sabantseva E.G., Ivanova E.V., Rabinovich I.M. Manifestations of allergic reactions that occur at a dental appointment. Dentistry.
2021;100(6‑2):29‑32.
Sabanceva EG, Ivanova EV, Rabinovich IM. Manifestations of allergic reactions occurring at a dental appointment. Dentistry. 2021;100(6‑2):29‑32. (In Russ.)
https://doi.org/10.17116/stomat202110006229

Read metadata

PURPOSE OF THE STUDY

Based on the analysis of data from modern scientific literature, conduct a study aimed at revealing the truth of an allergic reaction at a dental appointment.

MATERIAL AND METHODS

The article is based on the study of domestic and foreign research materials included in the eLibrary, PubMed, Cochrane Database Systematic Reviews databases. The study period was 15 years.

RESULTS

Among dental materials, the most common allergens are local anesthetics, metal alloys, composite material components, latex.

CONCLUSION

If allergy is suspected, it is necessary to carefully collect an anamnesis and conduct a clinical examination of the patient with the involvement of specialist doctors, recommending skin tests and a subcutaneous provocation test.

Keywords:

allergy

anaphylactic shock

local anesthesia

local anesthetic

filling materials

latex

nickel-titanium

methyl methacrylate

orthodontic structures

Authors:

Sabantseva E. G.

Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia

Ivanova E.V.

Federal State Budgetary Institution of Science Institute of Cellular and Intracellular Symbiosis of the Ural Branch of the Russian Academy of Sciences

• ORCID:
  0000-0002-4974-8947

Rabinovich I.M.

Federal State Budgetary Institution National Research Institute of Dentistry and Maxillofacial Surgery of the Ministry of Health of Russia

References:

1. Khamaysi Z, Bergman R, Weltfriend S. the clinical presentations. contact dermatitis. 2006;55(4):216-218.
2. Kal BI, Evcin O, Dundar N, Tezel H, Unal I. An unusual case of immediate hypersensitivity reaction associated with an amalgam restoration. Br Dent J. 2008;205(10):547-550.
3. Lugović-Mihić L, Ilić I, Budimir J, Pondeljak N, Mravak Stipetić M. Common allergies and allergens in oral and perioral diseases. Acta Clin Croat. 2020;59(2):318-328. https://doi.org/10.20471/acc.2020.59.02.16
4. Bains VK, Loomba K, Loomba A, Bains R. Mercury sensitisation: review, relevance and a clinical report. Br Dent J. 2008;205(7):373-378.
5. Meena Syed, Radhika Chopra, Vinod Sachdev Allergic Reactions to Dental Materials A Systematic Review. J Clin Diagn Res. 2015;9(10):ZE04-ZE09. https://doi.org/10.7860/JCDR/2015/15640.6589
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Allergic manifestations at a dental appointment is a large interdisciplinary problem that affects, on the one hand, dentists of all specialties, since the occurrence of allergic reactions is possible in the clinical practice of any dentist. On the other hand, identifying and confirming the issue of an allergen, treating allergies directly is the prerogative of an allergist.

The purpose of this review is to define criteria for a true allergic reaction at a dental appointment.

In 2006, Z. Khamaysi et al. [1] conducted a study of allergens in dental practice associated with contact reactions. Patch testing of 134 patients identified cheilitis and perioral dermatitis as the most common manifestations (in 25.6%), followed by burning mouth syndrome (BFS) (15.7%), lichenoid reactions (14%), and orofacial granulomatosis (10 .7%). The most common contact allergens were: sodium thiosulfate (14.0%), nickel sulfate (13.2%), mercury (9.9%), palladium chloride (7.4%) and 2-hydroxyethyl methacrylate (5.8%) [1].

Amalgam, a mercury-based filling material, is practically not used in modern dentistry, but the population still has enough restorations from this material. A delayed-type hypersensitivity reaction to amalgam restorations manifests itself as erythematous, itchy lesions on the oral mucosa, face, and neck. The common manifestations of these reactions are lesions of the oral cavity with lichenoid [1, 2] and orofacial granulomatosis [3]. Among 29In 10 patients with lichen planus of the oral cavity, an allergic reaction to mercury was observed, and when the amalgam was replaced with a composite or glass ionomer, the lesions disappeared [4]. Another manifestation of mercury allergy is FBP [5].

If the contact reaction in patients often manifests itself on the oral mucosa, then studies among medical dental personnel revealed the presence of skin diseases in 30-50% of the examined [6]. Most often, dental clinic staff suffer from hand skin dermatitis as a manifestation of an allergy to metals, latex, antimicrobials, preservatives, and methacrylates [1]. The most common cause of allergies among dental staff in Europe and the United States are gloves and denture materials [7, 8].

In the literature, the most common information is about allergies to chromium-nickel alloys, including those used in dentistry. In the studies of J. Covington et al. [5] noted that nickel is the most common sensitizer among metals. Nickel allergy is 4–10 times more common in women than men [9], while chromium allergy is inversely related (in 10% of men and 3% of women) [5]. Clinical signs and symptoms of nickel allergy include: burning sensation, gingival hyperplasia, numbness of the lateral surfaces of the tongue [10]. In sensitized individuals, reaction to nickel leads to systemic allergic contact dermatitis [5].

In a study by I. Duarte et al. [11] tested 1208 patients with contact dermatitis. The authors found that 18.5% tested positive for two or three metals. Allergy to titanium has a low prevalence (0.6%) [12] and is manifested by urticaria, eczema, reddening of the mucous membrane [5]. In studies by K. Müller and E. Valentine-Thon [13], 56 patients after the installation of titanium implants, orthodontic treatment or endoprosthetics developed serious health problems (muscle and joint pain, chronic fatigue syndrome). In a prospective study by A. Sicilia et al. [12], monitoring 1500 patients with dental implants for 3 years, described the occurrence of an allergy to titanium after implantation. It has been observed that the presence of elements such as beryllium, cobalt, chromium in titanium alloys can cause allergic reactions in patients after implantation.

A large class of potentially allergic dental materials are polymers, acrylates and composite filling materials. According to the literature, it is the organic component of composites that can cause allergic reactions. The organic matrix consists of a mixture of monomers, mainly represented by methacrylates: BIS-GMA, TEGDMA, HEMA, EGDMA. Allergy to methyl methacrylate (MMA) is most often mentioned in the literature in both patients and medical personnel. The prevalence of contact allergy to MMA averages 1% [5, 14], however, studies conducted in Sweden showed that screening revealed contact allergy to MMA in 2.3% of patients and 5.8% of medical staff. The most common allergen was the HEMA-2 monomer. Dental staff frequently complained of contact dermatitis and asthma caused by methacrylates. According to W. Marquardt et al. [15], it is HEMA, EGDMA and TEGDMA that are responsible for occupational contact allergies in dentists.

Although resin-based restorative materials are considered safe, it is typical for these materials to not fully convert the composite component during the polymerization process. Their components can cause allergic contact stomatitis in patients, which is manifested by mild erythema of the mucous membrane of the cheeks and gums [16–18]. U. Hallstrom [19] reported individual cases of asthma and urticaria reported after fissure sealant: the symptoms disappeared after its removal, suggesting an allergic reaction.

Among the materials used in endodontics, formaldehyde, sodium hypochlorite, eugenol are most often mentioned as potential allergens in the literature. Allergy to formaldehyde is more common in women, mainly eczema on the hands or face [5]. The dental literature describes 28 patients with immediate symptoms associated with root canal filling with pastes containing formaldehyde [20]. Formaldehyde allergy is characterized by anaphylactic reactions [21–22] and generalized urticaria [20, 23]. The most useful diagnostic tool for identifying formaldehyde allergy is the assessment of specific IgE antibodies [23].

Only a few cases of hypersensitivity to sodium hypochlorite have been reported [24]. In one case, while washing the canals, the patient developed a burning sensation and difficulty breathing, and corticosteroids, antibiotics, antihistamines, and analgesics were prescribed to relieve symptoms. After 15 days, the patient’s allergy to sodium hypochlorite was confirmed by an intradermal test [5].

Allergy to zinc oxide is rare [5], but eugenol acts as a contact irritant and causes type IV hypersensitivity reactions and general anaphylactic symptoms [25]. An allergic reaction to eugenol was observed in a patient with gingival inflammation in the area adjacent to the metal-ceramic bridge [25]. Allergic contact stomatitis has also been reported when eugenol was used as a temporary restorative material and the lesion healed when replaced with a glass ionomer [26].

There are reports of allergic reactions to polyester impression materials, which manifested as swelling, itching and redness [27, 28]. S. Gangemi et al. [29] report a case of anaphylactic shock that developed as a reaction to an alginate impression material.

The prevalence of latex allergy in the population is 1% [5]. It can have serious consequences, including the development of anaphylaxis. The literature describes cases where the treatment of a patient with a rubber dam and local anesthesia resulted in angioedema, which was associated with the use of a local anesthetic and was treated with corticosteroids and antihistamines. And only repeated treatment with the imposition of a rubber dam and more severe manifestations of edema and respiratory failure revealed the true cause. The patient was subsequently confirmed to be allergic to latex [30].

Anaphylactic reactions occur within minutes of the administration of local anesthetics, most commonly during dental procedures. Significant symptoms, including respiratory failure or loss of consciousness, often raise the suspicion of an allergy and may prompt patients and clinicians to avoid anesthetic injections in the future. However, true allergic reactions to local anesthetics are extremely rare, accounting for less than 1% of all reactions. In addition, many of these allergic reactions are not caused by the anesthetics themselves, but by the preservatives they contain. K. Al-Dosary et al. [31] reported a patient allergic to lidocaine and tolerant to articaine. She was a 12-year-old girl with anaphylaxis caused by lidocaine (an amide local anesthetic). Allergy was confirmed by a positive skin test for the drug. Skin tests and administration of another amide anesthetic (articaine) were negative. Subsequently, the use of articaine was well tolerated, ie. articaine may be a suitable alternative, but after a confirmed negative skin test and challenge test.

The time elapsed since the last allergic reaction is important in risk assessment. According to the results of the study by A. Janas-Naz et al. [32], the occurrence of angioedema increased the risk of detecting type I hypersensitivity by 68.8 times, but every year without allergic reactions, this risk decreased by about 55%.

Non-allergic mechanisms are responsible for most immediate-type reactions caused by local anesthesia. How not to miss a true allergic reaction to local anesthesia? A. Trautmann et al. [33] retrospectively assessed patients who presented to the clinic for the diagnosis of immediate-type reactions caused by local anesthetics during the last 20 years. Of the 402 examined patients, 29had an episode of acute urticaria within 30 minutes of anesthetic injection, and the remaining 373 had a history of mostly subjective skin, respiratory, cardiovascular, and neurological complaints. Of the patients who reported urticaria with or without angioedema, 14 had a spontaneous episode of urticaria and 13 had allergic or non-allergic reactions to other agents.

I. Kalkan et al. [34] suggested that although cross-reactivity between local anesthetics of the amide type is rare, in patients with hypersensitivity to one of them, tolerance to other drugs from this group should always be confirmed using a control test. Perhaps it is not cross-reactivity but different sensitizations with more than one existing allergen structure other than the aromatic ring. Although the search for an alternative local anesthetic is clinically valuable because it ensures the safety of treatment, there is a risk of underestimating the true frequency of hypersensitivity to local anesthetics in these populations. Ideally, the primary goal of a provocative test should be to refute the allergy rather than confirm it.

M. Dey et al. [35] described a clinical case of a 70-year-old patient who complained of itching and urticaria 24 hours after treatment. Increasing concentration testing of subcutaneous injections of lidocaine was undertaken, confirming type IV hypersensitivity to it. The same test was then carried out for 4% articaine hydrochloride, which was found to be negative even after 72 hours. Thus, it was confirmed that the patient was not allergic to articaine and successfully underwent endodontic treatment with it. Although allergy to lidocaine is rare, a detailed medical history should be obtained from any patient who will be treated under local anesthesia.