A protocol proposal for safe dental anaesthesia in paediatric patients with allergic backgrounds: insights from a case series of allergic patients.

purposePaediatric patients with complex allergic backgrounds pose unique challenges in dental treatment requiring local anaesthesia (LA). This report aims to present a structured clinical approach for the dental management of paediatric patients with complex allergic backgrounds, including systemic mastocytosis, prior anaphylaxis, drug hypersensitivity, and latex allergy, using local anaesthesia (LA) in a hospital setting. CASE REPORTS: This case series describes four paediatric patients with elevated hypersensitivity risks prior to the dentoalveolar treatment. All underwent multidisciplinary preoperative evaluations and received tailored management plans. Patient 1 (anaphylaxis history): treated with preservative-free mepivacaine with intravenous access and strict intraoperative monitoring. Patient 2 (systemic mastocytosis): received prophylaxis with oral H1-antihistamines and intravenous prednisolone before treatment with mepivacaine. Patient 3 (erythema multiforme and drug hypersensitivity): managed with lidocaine following a negative skin test, interpreted with caution. Patient 4 (latex allergy and asthma): latex-free protocols were applied, and lidocaine was used under controlled conditions.

conclusionTailored prophylaxis strategies and the use of preservative-free amide-type anaesthetics were associated with uneventful outcomes in these cases. This structured approach highlights the importance of individualised emergency preparedness and interdisciplinary collaboration in high-risk paediatric dental procedures.