Information Sourced May 2020
https://bnf.nice.org.uk/guidance/prescribing-in-dental-practice.html

A severe allergic reaction may follow oral or parenteral administration of a drug. Anaphylactic reactions in dentistry may follow the administration of a drug or contact with substances such as latex in surgical gloves. In general, the more rapid the onset of the reaction the more profound it tends to be. Symptoms may develop within minutes and rapid treatment is essential.

Anaphylactic reactions may also be associated with additives and excipients in foods and medicines. Refined arachis (peanut) oil, which may be present in some medicinal products, is unlikely to cause an allergic reaction—nevertheless it is wise to check the full formula of preparations which may contain allergens (including those for topical application, particularly if they are intended for use in the mouth or for application to the nasal mucosa).

Symptoms and signs

• Paraesthesia, flushing, and swelling of face
• Generalised itching, especially of hands and feet
• Bronchospasm and laryngospasm (with wheezing and difficulty in breathing)
• Rapid weak pulse together with fall in blood pressure and pallor; finally cardiac arrest

Management

First-line treatment includes securing the airway, restoration of blood pressure (laying the patient flat and raising the feet, or in the recovery position if unconscious or nauseous and at risk of vomiting), and administration of adrenaline/epinephrine injection. This is given intramuscularly in a dose of 500 micrograms (0.5 mL adrenaline injection 1 in 1000); a dose of 300 micrograms (0.3 mL adrenaline injection 1 in 1000) may be appropriate for immediate self-administration. The dose is repeated if necessary at 5-minute intervals according to blood pressure, pulse, and respiratory function. Oxygen administration is also of primary importance. Arrangements should be made to transfer the patient to hospital urgently.