Anaphylaxie auf dem zahnarztstuhl - Eine ungewöhnliche manifestation einer kontakturtikaria

During a root canal treatment a 49-year-old insurance agent developed a severe anaphylactic reaction with oro-pharyngeal swelling, respiratory distress and unconsciousness. Although glucocorticosteroids were given systemically, the swelling persisted for several days. Patch testing revealed a local urticarial reaction to the root filling material and to epoxy resin in the patch test standard series after 20 minutes. In a second patch test, we could identify the epoxy resins based on digylcidylether of bisphenol A and F, respectively, used in the root filling material ((2,2-bis(4-(2,3-epoxypropoxy)-phenyl)-propane and bis-(4-(2,3-epoxypropoxy)-phenyl)-methane)) as the relevant allergens. During this second testing, the patient developed a generalized urticarial rash after one hour. Although the patches were removed after 20 minutes, a strong positive reaction was seen after 72 hours. This case demonstrates that epoxy resin, an allergen which usually induces contact dermatitis, may cause contact urticaria too, and may lead to a strong anaphylactic reaction when applied on mucous membranes.