According to Dr. Escribano and his REMA protocols which we have posted here on the site,
http://mastcelldisorders.wallack.us/yabb/YaBB.pl?num=1293571751/4#4 we do have to be careful with local anesthetics. And according to his protocols, amide-derivative group of anesthetic is safest.
"4.6. Local anestheticsķ: Exceptional using amide-derivatives "Now when Dr. Escribano states "Exceptional" he is saying that while using the REMA protocols it has been exceptional when a patient has reacted to amide-derivatives. In other words, it is extremely unusual that a patient will react to this while using his protocols.
I've spoken with Dr. Ecribano regarding these protocols because I translated them into Portuguese for him. He explained to me that this use of the word exceptional is in it's classic form, meaning highly unusual. Also, because I am a rare case and have severe reactions to procedures and such, in trying to find out why I would react when most masto patients would not I found out what he meant by this:
"ķNo adverse reactions were recorded in 850 bone marrow biopsies and 1,235 cutaneous biopsies. In these cases, adequate premedication was used (REMA, unpublished data, 1984 2006). In 8 cases with previous history of anaphylaxis induced by stress, the bone marrow biopsies were performed in the ICU with premedication, local anaesthesia and sedation (CLMast, unpublished data, September 2010)."
According to Dr. Escribano there is a group of us patients who are extremely sensitive - that our systems are extremely sensitive and we will react to things which stress our systems. He calls this "Stress Anaphylaxis". This means that mediators coming from our stress system will trigger us easily. So, the physical AND/OR emotional stress of going through a BMB or sitting in a Dentists chair is enough to trigger anaphylaxis. For those of us who have this tendency, we should not do procedures outside of either the OR or the ICU! We MUST be premedicated prior to the exam, we need to have an anesthesiologist ON HAND overlooking the procedure, ready to jump into action should the patient begin to react. The patient should be sedated as well as premedicated. This is what the protocols require for this kind of patient.
This doesn't mean that you are "overly anxious" or "overly emotional" and I just went through an MRI with an anesthesiologist ON HAND, hooked up to the machines and monitored. I did not have sedation for the anesthesiologist saw that I was calm and doing well and since I don't do well with those meds, we felt it was better. However, I did react to the contrast about an hour following the exam. But during it, for the most part, I was fine. I knew that the doctor was on board and that he was understanding and that everything was going well. And when he saw that I was having some trouble, later on, after the exam was over, he even stated that the trouble was not emotionally created. It was created by having to hold my breath repeatedly, that this causes me to faint. It was a real victory for I finally had a doctor seeing all of this going on, seeing that it was not emotionally caused and that it was having to hold my breath which was the problem here. But, I was in a perfectly safe situation, in a hospital and with an anesthesiologist ON HAND ready to take action in case I got into trouble. This is how it should be done for those of us who are this sensitive to exams.
As to dental work, the last time I had any done, it was in the OR. When I had my BMB it was in the OR under general anesthesia. My other procedures are done the same as well.
I am sorry for your having reacted to the local, but perhaps you are a patient, like me, who goes through Stress Anaphylaxis.
I hope this helps.
Lisa