Dental MythBuster #10 – I’m allergic to epinephrine!

For this 10th Dental MythBuster, I’ve decided to tackle one of the greatest ones out there: The mythical epinephrine allergy!

Epinephrine used at the dentist photo people think they are allergic

Epinephrine for injection.

I consistently hear some variation of the following at least twice a month in my office in Orange, CT:

“Doc, for the shot, don’t use the one with epinephrine. I’m allergic to it.”

Upon hearing that, I always use a dental local anesthetic that does not contain epinephrine. But in all cases, the patient is improperly using the word “allergy.” Let’s see why.

About Epinephrine

Epinephrine, also called adrenaline, is a naturally occurring hormone and neurotransmitter in the body. It plays a critical role in the “fight or flight” response. Epinephrine has a number of different functions, including increasing the heart rate, regulating lung capacity, increasing the amount of available glucose, and many others.

Picture of epinephrine used in dentistry by dentists

Structure of Epinephrine

In addition to being naturally released by the body, epinephrine can be administered by health care providers in many situations. Epinephrine is given in many situations of acute cardiac arrest (a heart attack). It is also given in the treatment of an acute allergic reaction called anaphylaxis. It is frequently sold in an injectable form called EpiPen for those people susceptible to these types of reactions. We have an EpiPen in our office in Orange, CT as part of our emergency kit.

But the critical thing to keep in mind is that every single person produces and releases epinephrine all the time.

Why Dentists Use Epinephrine

As a dentist, I inject local anesthetic containing epinephrine at least ten times per day. Epinephrine is used because it acts to constrict the blood vessels in that area. By doing so, the local anesthetic remains in that area longer, because there is less blood flow to take the local anesthetic away. Simply stated, the epinephrine helps you feel and stay number longer.

As anyone can imagine, a dentist who does not get their patients adequately numb will soon find themselves with an empty chair! And epinephrine is a key factor in keeping patients adequately numb for procedures.

An Epinephrine Allergy?

So how can you have an allergy to a substance that your own body produces and uses every second of the day? The answer is it’s impossible! If you were allergic to it, you would be developing symptoms all the time! I won’t bore people with the technical definition of an allergy, but this is a good summary.

Carpule of lidocaine and epinephrine used by dentists in our Orange CT practice

Lidocaine with epinephrine.

So where did this myth originate? Well, most people confuse an adverse reaction with an allergic reaction. Common adverse reactions to an injection of epinephrine at the dentist can include:

  • Your heart starts to beat much more rapidly.
  • Your heart starts to beat much more forcefully.
  • The skin on your cheek – near the injection site – gets very pale.
  • You become suddenly dizzy.
  • Your shirt becomes wet from sweating (called diaphoresis).
  • You become very nervous.
  • You develop a headache.
  • And many others.

In addition, many other patients are unable to receive epinephrine due to certain medical conditions and/or medications they are taking. But this is NOT because they are allergic to it!

Dental Myth Busted!

Just like the other dental myths that I have written about (dentists no longer use novocaine, the dentist put his knee on my chest to pull my tooth, etc.), let’s bust this myth! So the next time you are at the dentist and you don’t want epinephrine, you should say:

“Doc, for the shot, don’t use the one with epinephrine. I had an adverse reaction to it.”

Until the next Dental MythBuster…

Note: since publishing this post there have been literally dozens of comments and posts which attacked me personally and/or used profanity. These comments prompted me to publish a sequel to this titled More on the Fabled “Epinephrine Allergy”. Please note that any/all comments with personal attacks and/or profanity will not be published.

Comments

  1. Jennifer says:

    I had always thought that the amount of epinephrine in the anesthetic was too small to produce the shaking, fast heartbeat, sweating, etc, that signal an “adrenaline rush.” I thought that my reaction to the injection with epi was a result of my own body recognizing the small amount of epi and responding as if it meant an emergency by dumping large quantities of my own epinephrine/adrenaline (different names, same chemical, I think!) into my bloodstream. I live in VA, and recently joked with my dentist that, if he forgot and gave me the anesthetic plus epi, I could turn the room into a credible imitation of Mineral, VA (where there was quite a large earthquake not long ago). Thankfully, he has noted in my record that the epi bothers me, so he doesn’t use it. (I have an awesome dentist, and he doesn’t seem to need the extra time the epi would provide, anyway!)

    • Jennifer,

      An adult Epi-pen has .3 mg of epinephrine. The amount of epinephrine in a standard dental injection is .018 mg. Basically, the Epi-pen has sixteen times as much epinephrine as the dental injection. But if you think about the PROFOUND effects an Epi-pen can produce, you can easily see how a smaller quantity injected into a very vascular area – the oral cavity – can produce systemic effects too. An Epi-pen is injected into the side of the thigh – a muscular area – that does not have the same vascular properties of the oral cavity.

      So yes, the heart racing and slight sweating is from the epi in the injection, not your own. Unless of course you get so nervous that you’re already having an adrenaline rush!

      Thanks for the well-thought out comment.

      • Malissa says:

        Thank you for your posts. Could you tell me, please, is there anything other than epinephrine that doctors and health professionals can use in cases of anaphylaxis. I have been told by several doctors that I have a highly sensitive system.
        Also, in the posts, it was mentioned that epinephrine is used in anesthesia. My doctors are discussing possible sinus surgery for me. Epinephrine causes me to shake violently . . that scares me with thinking about shaking like that while they are working on my airways. Please note these are two separate questions. (I have had lidocaine/epinephrine numbing shots at two separate occasions, years apart to have skin biopsies (which came back fine) and each time I shook violently, heart raced and caused chest to hurt, hard a difficult time breathing, and kept blacking out. This lasted for two hours and was much worse after the second time.) Furthermore, I was given a shot years ago in the ER for reaction to a bee sting which was only swelling at the time, but after the shot, my heart raced so much it stopped, which is what I was told by the ER doctor. He told me to never use epi again.
        So, is there anything that can be used as an alternative to epi?
        And, should I be worried about anesthesia? Is there a way they can give me anesthesia without epi?

        Thank you again for your posts. They have been very informative. I understand the allergy/adverse reaction difference .. .different mechanisms, yet both have possibility of being very dangerous and even life threatening.

        • Malissa,
          Thanks for the comments. You are not alone in being very sensitive to externally administered epinephrine.
          Keep in mind that anaphylaxis, if untreated, can frequently lead to death. I wasn’t there for the bee sting. Perhaps the epi was given a bit over-zealously. Mild and localized allergic reactions do NOT need epinephrine. Typically 50 mg diphenhydramine (benadryl) is given for mild, localized reactions. But, keep in mind that in this overly litigious society, if the ER doc did not give you epi, and your reaction to the bee progressed quicker than expected, he/she would be liable. It’s unfortunate society has become this way.
          Your question regarding the sinus surgery all depends on the extent of the procedure. Generally speaking, nearly all procedures in dentistry, including ones involving the sinus, can be done without epi. Your comment is unclear as to the extent of the surgery and anesthesia. Are you being sedated? If yes, to what degree. In very significant procedures where a breathing tube is placed down your throat, you are given medications that paralyze a lot of your muscles. This would theoretically prevent movement of your voluntary muscles.
          I am glad you understand the difference between an allergic reaction and an adverse reaction.
          I hope this helps.

          • Malissa says:

            Thank you for responding. I’m sorry I did not mention the reaction. I stepped on the bee, but within minutes my lips and tongue were numb and by the time I got to the ER, my lips were swollen and I was wheezing. I cannot use Benadryl.
            Yes, I was told I would be “put under,” not just using conscious sedation.
            The more recent severe reaction to the epi from just the numbing medication is what concerns me most as that is a minute amount compared to being given epi for anaphylaxis. Do you know is there any other medication that can be used as an alternative to epi or benadryl? I have not been able to find any answers to this question. I do have severe and numerous allergies and hypersensitivities. Any words of advice and caution is greatly appreciated.
            Thanks again!

          • Malissa,
            If you’re being “put under” then you will likely having a consult with the anesthesia team. You should express your concerns to them. While I know a lot about pharmacology for dentistry, I am not qualified to comment on alternatives to epi and/or benadryl in cases of anaphylaxis. I wish I could help though. Good luck!

    • I think this is a bit disengenuious to state that people cannot be sensitive to epinephrine just because it is a “natural” molecule found in our bodies. As a toxicologist and a dental patient who actually can confirm an official diagnosis of a sensitivity to epinephrine used in select medications/analgesics (dose make the poison, as we say), I take issue with you telling people that it isn’t the case. People would be wise to do actual scientific research as well.

      Ad hominem attacks deleted. Why is this poster being so aggressive?

      There are always subsets of people or sub populations who have unusual responses or might be hypersensitive to select medications.

      • Gale,

        You claim to be a toxicologist but based on what you wrote I highly doubt you are. Did you even read my post? You need to read it again.

        I never wrote that you cannot be sensitive to epinephrine. Please point out where I wrote that.

        You need to go ahead and review what “allergic” and “allergy” means.

        Let’s review some very basic human physiology and pharmacology:

        If you drink half a beer and then become nauseous and pass out, it doesn’t mean you are allergic to it. You are a hyper responder.

        If you take an antibiotic and end up with a UTI, it does not mean you are allergic to it. You experienced an adverse drug reaction.

        If you are touched by a latex glove and not soon thereafter develop a skin reaction, you are likely experiencing a delayed allergic reaction.

        If you eat a peanut and then immediately develop hypotension, angioedema, pruritus, dyspnea, wheezing, and a plethora of other symptoms, you are likely experiencing a severe allergic reaction. Want to guess what drug is administered for that?

        If you develop a racing heart after an injection with local anesthetic with epinephrine, it does not mean you are allergic to it. You experienced an intravascular injection which would be classified as an adverse drug event.

        If you feel you are sensitive to epinephrine, you certainly may be, just like some people are more sensitive to medications and some people are less sensitive. The mechanism behind that is likely complex (receptor up regulation, insufficient levels of COMT, concomitant use of a Beta blocker, etc.) But the mechanism is not allergic in origin.

        In the time it took you to read this, your own body has synthesized and released millions of epinephrine molecules. If you are allergic to it, how come you are not experiencing an allergic reaction?

        Lastly, I find your gross generalizations and criticisms of the dental profession to be not only unprofessional but also disgraceful. I’ll leave it at that.

        • Marcia Costa says:

          Dear Dr. Nicholas,

          Some people unfortunately does not have the gift of the written expression in regards to what they intend to say. You do have this gift, and the generosity to share it with us.
          If you feel “under attack”, just disregard.

          Attacking someone for what you do, especially when intentional, is at very least, low and unfair.

          You are way above this level of communication, and I, and many people who benefit from your wealth of knowledge are blessed to be part of your discussion.

          And, I am a Veterinarian and a Toxicologist.

          Warm Regards,
          Marcia Jones Costa

        • I have been studying up on this, as my doctor recently listed this as an “allergy” on my medical record because in November, the dose of lidocaine and epi I received almost killed me. I was in hypertensive crises, BP 220/150, HR 200s, convulsing, hallucinating, hyperventilating, developed an arrhythmia and a murmur. I spent several days in an ICU following this incident and was told to wear a medical bracelet stating epi should not be used on me. I am a nurse. I understand anatomy and physiology, and I also tutor pharmacology. I know that epi is naturally produced; however, when we administer medications, it is a synthetic form of epinephrine, not the naturally produced neurotransmitter in our body. Maybe it was a fluke, but I’ve been to several doctors, and they have no other explanation besides the epi in my situation.

          • Kyra,

            Your incident is obviously complex and there is no way I can possibly know what went on.

            Might the epinephrine have produced the symptoms? It’s possible. But having an episode like that does not make you allergic to it. That’s one of the many points of the post.

    • I recently went to dentist and after epi shot went into shaking uncontrollably. I’m 69 years old and needless to say been to Dentis many many times. My heart rate went to 185 and they covered me with blanket to warm me. The shaking finally stopped as the medication wore off. I ask to not have my dental work done and left. It truly scared me as I had a stroke only approximately 5 months ago. NO EPI again! It is serious and people need to be aware of this.

      • DJ,

        I was not there to observe what happened but based on your description some of the epinephrine from the injection entered your bloodstream and travelled to your heart, causing it to race. I can imagine that it was unpleasant. Of the many effects that epinephrine elicits, an increase in heart rate is one of them. So note that this is not an allergic reaction but simply one of the effects of the medication.

  2. bernice says:

    I understand your point. But if it’s not the epi, what could it be? On 2 occasions I went to the dentist and developed swelling on my lips/hands and a horrible rash. Requiring to go to the ED. Please help!

  3. Marty Moor says:

    It could be the preservatives in the medication. And yes, you can be allergic to that. Fortunately, there are local anesthetics available that are preservative-free.

    • Marty,

      Thanks for the comment.

      You are correct in that there are instances of allergic type reactions to the preservative – methylparaben – found in local anesthetics.

      What your comment fails to point out is that an allergic reaction presents much differently than a reaction to exogenous epinephrine. Swelling, edema, eyrthema, urticaria, etc. are all hallmarks of allergic reactions. A sudden increase in heart rate, unexplained sweating, etc are most likely explained by a bolus of epinephrine entering the cardiovascular system. So your assertion that an allergic reaction to the preservative could produce these types of epinephrine-like symptoms does not make much sense.

      • Thank you for posting this. I have been searching for answers after a trip to the dentist turned scary. Basically shortly after injection I passed out and started having seizures. When I came to my fingers and toes were in a deformed paralyzed state and I felt like I was being crushed to death. Paramedics took me to ER and in about an hour I was normal again. I do feel as if I suffered some long term brain effects. I heard that I could be allergic to epi which scared me since I have an epi pen for bee/wasp allergy. So you could imagine why I have been searching for answers. I have took the med without epi and have been just fine.

      • If there are sulfites in the anesthetic preservative and you are sensitive to sulfites it can cause full blown panic attacks, rapid heartbeat etc. I have that reaction with Novocaine and Lidocaine. I am not the least nervous about dentistry in general but become a shaking mess in the dental chair because of my reaction after the injection.

        • Frances,
          Thanks for the info. I blogged about this already in this post:
          http://directionsindentistry.net/novocaine-allergy-part-ii-methylparaben-sulfites/
          I should probably update this post with a link to the sulfite sensitivity article.

          • Thanks for the info – read the article but was annoyed that the doctor said that unless you are asthmatic, sulfite sensitivity is very uncommon. I think it’s a lot more common than he or she thinks. I am not, nor ever have been asthmatic. I also suspect that many people who have anxiety and panic attacks may simply be reacting to sulfites. I can tell you it is very un-nerving for a dentist to have to try to work on someone who is trembling, hyperventilating and has a rapid heartbeat! The problem is that most patients aren’t aware of this sensitivity so can’t/don’t ask for the right anesthetic!

      • Marcia Jones Costa says:

        Dear Dr. Nicholas Calcaterra,

        Your explanations on lack of allergy to epinephrine are very clarifying to lots of people who have reactions when administered any epinephrin shots, wheter at the dentist, through an EpiPen, or even at the ER.

        Maybe there’s more a semantics discussion on the terminology or cause of the symptoms, but the truth is that side or adverse effects can be fatal too, regardless from an anaphylactic shock (allergy) or an adverse reaction.
        I am a Doctor of Veterinary Medicine, Toxicologist and Public and Environmental Health Specialist, and most unfortunately, I also suffer from sulfites allergies, being garlic (allicin) my most powerful aggressor, which prevents me to eat out, and makes my contact with people that eat it regularly very difficult.
        It is also true that we all have natural Epinephrin in our bodies, but under normal circumstances, we only produce as much as we are able to metabolize, with no added preservatives; however, under violent, sudden or stress conditions, if a person is sensitive to Epinephrin, serious, even fatal events can occur.
        I do not believe that anyone in particular had the intention of attacking you, it is more like a lack of a proper manner to address how much they have been through, however, not said in a proper manner.
        I have to agree with your statement about not being an allergy, but once someone mentions the term, the health professionals will be alerted to the fact that maybe this patient is not a candidate to the drug.
        Toxic is any substance that exceeds our metabolic ability – whether water, sugar, salt, ice cream, etc…
        High toxicity also kills, even though not by an allergic reaction.

        Congratulations to make your self so available to the public in general, and for the generosity of your time explaining what people should know and be aware of.

        Most Sincerily.
        M.J.C., DVM

        • Marcia,

          Thank you for your comment.

          You make a point about semantics. To many, allergic vs. adverse seems to be just that. However, in this litigious society that health care providers must live in, the distinction between allergic and adverse is important. I am sure there have been physicians sued over something that many would just consider “semantics.”

          The typical dental injection with epinephrine contains .036 mg epinephrine. Unless the needle inadvertently comes into contact with a vessel, the epinephrine typically stays in the general area of the injection.

          Consider a stressful situation – such as an impending extraction – in someone who is nervous. Waiting in the reception area, going into the room, reviewing the paperwork, getting the injection, waiting for the local to kick in, then having the actual procedure done. Over the course of that time period, your adrenal medulla releases far more epinephrine than what is going to be injected into you. Frequently, then, when an issue comes up – such as a stroke – some of the blame must be laid upon the endogenous epinephrine.

          Lastly, I am glad that you are aware of your sulfite sensitivity/allergy. Many dentists are just not aware of this phenomenon which can lead to issues.

  4. Sarah Kathryn says:

    I agree with the allergy part, as there is no known allergy to epinephrine, however it is a problem. After I had my first two wisdom teeth pulled, I became violently ill, dehydrated, and honestly, puking my guts out. After calling the dentist to see if this was normal, he went through my procedure and paperwork and first determined I was allergic to Novacaine and Lidocaine, but after further research, it was the epinephrine in both of those that I had the reaction to. I have a medic alert bracelet for it, and on this it says a fatal reaction. Because although it is naturally occurring in my body, it is a type of allergy that causes the unnatural substances or the ‘overdose’ of it to cause my illnesses. If I do have it again, it is very possible that I could die. Just like a normal allergy. I do agree with your post, I just wish it was worded differently.

    • I also had the same reaction as you with Epi twice at the dentist. I was taken to the ER and the Novcaine was flushed out of my system since 18 hours had gone by and the effects were still in my system. The most recent incident I told the Dentist not to give me Epi he still injected me and refused to listen. Since then I feel electric currents running across my chest. Ad hominem attack deleted by Administrator.

      • It is unfortunate that you must resort to personal attacks when an individual presents you with facts that contradict your beliefs. I hope you do not behave like this offline.

        Normally, I would attempt to provide additional facts that would convince any open-minded individual that an allergy to epinephrine (which is running through your bloodstream and being released at the synapses in your nervous system as I write this) is not possible. However, it is apparent that these words will fall on deaf ears and blind eyes. So I won’t waste my time (nor yours).

        • Mom of 6 says:

          Second set of ad hominen attacks deleted.

          My son’s reaction to epinephrine is the opposite of what most here claim. He becomes extremely lethargic with swelling and numbness for 24+ hours. He said he also feels really dizzy and “weird” all over. What you’ve said here about it being an “adverse reaction” and not an allergy makes sense.

          Third set of ad hominem attacks deleted. Were those really necessary?????

          • It is unfortunate that you again must resort to personal attacks against me.

            I find it ironic that you ultimately end up agreeing with the central thesis of the article. I have left that portion of your post for all to see.

            I wish you and your son all the best in getting the answers you wish to find.

        • Gail Choate says:

          Dr. Calcaterra,
          Thank you so much for clarifying this question I have had for years. I to have a reaction to Novacaine w/Epi. I have often wondered about being “allergic” to Epi… All the “what if’s” come to mind as in: what will happen if I ever need Epi? I’m glad to know its a naturally occurring part of my system and I’m not allergic to it.
          I usually ask for Carbocaine and it never causes a reaction. Are there other ones that are similar? I was told that this was used on heart patients and works well.
          If a get Novacaine w/Epi I first feel like someone threw ice water on the back of my neck then my ears stuff up then tunnel vision with extreme shaking and sweating. I gasp for breath as these other things are occurring. It’s so embarrassing and I feel like I’m going to die or lose consciousness. I’m not scared of the Dentist or the shot but I am embarrassed by the reaction I have lol!
          Thank you for reading my story…

  5. I am curious about something. I have always been fairly side effect sensitive to medications, I recently had some dental work done and noticed the common feeling of having a Panic Attack, as I’ve had several severe Panic Attacks in the last few years. This first time at the dentist is was minor and I brushed it off, the second time, I almost passed out in the chair. The reaction I had was that of one of my severe Panic Attacks that generally end with me passing out. My vision goes out, my hearing goes out, my heart races, I am severally nauseous, incredibly dizzy and disoriented from my vision and hearing. I was immediately aware of the reaction i was having and did not panic to much but explained my symptoms and My dentist was kind enough to make a note that I did not tolerate that kind of anesthetic.

    My question is, if I can have that severe of a reaction to such a small does of Epinephrine, what does that mean for larger dosses? Are there any other medication like this I need to be aware of for future reference. Just because I am aware of the reaction while I’m having it, does not make it any less terrifying or make the after effects any better.

    • Laural,
      I was not there to see your panic attack. But based solely upon your description, this sounds like vasovagal syncope (http://en.wikipedia.org/wiki/Vasovagal_response). It does not sound like any type of allergic reaction. Now these episodes can be triggered by certain events (i.e. the needle at the dentist, the sight of blood, etc.). But they are not allergic in origin. Your symptoms match the wikipedia description almost completely. You can still avoid epinephrine at the dentist if that makes you feel more comfortable.

  6. Christine says:

    While being treated for anafalaxis, I was given epi iv. I could feel it stinging traveling up my arm. I then had a grand mal seizure and woke up 3 hours later. Am I wrong to worry about epi pens?

    • Christine,
      The standard of care for acute anaphylaxis is epinephrine. I can’t know the reason why you suffered a grand mal seizure – that is complicated and only the physicians treating you would know the answer. Regarding epi-pens, that is the standard of care, but I would check with your physician to make sure it is appropriate for you.

      • Christine says:

        Thanks, that happened in the ER after having pulminary adema and anafalaxis from being bitten by hundreds of black flies in upstate NY. I’ve told Dr.s about the event, and they have avoided it in general since. Which is scary considering I’m allergic to bees. I even had an allergic reaction to a McDonalds hamburger as a child- where my face became so swollen I had to be hospitalized for 5 days…good times

  7. Amy Bright says:

    Epinephrine used in anesthesia and epi pens contains preservatives. The preservatives cause the allergic reaction. In my case, I experience shock, paralysis, and a high fever. Even though the allergy is not to epinephrine itself, I still am unable to have epinephrine in these synthetic forms. So, for all intents and purposes, it’s easier to say the allergy is to epinephrine.

    • Amy,
      Thanks for the comment. You are correct – nearly all injectable local anesthetics contain one or more preservatives. I will be writing about allergic reactions to those preservatives in part II of an upcoming post (part 1 is located here).

      You appear to be mixing up an allergic reaction with an unanticipated adverse reaction to epinephrine. The details are located in this post. But to summarize, epinephrine can unexpectedly enter the bloodstream, leading to a racing heart, sweating, and other symptoms. People mistakenly think this is an allergic reaction while in reality it is not. The preservatives in the injection do not cause these symptoms. In the case of an allergic reaction to preservatives, the patient experience radically different symptoms. So you really can’t say that the allergy is to epinephrine – because that is impossible.

  8. Ann Marie says:

    I found out that i was allergic to epinephrine when I was 10 years old. I had an asthma attack and children’s hospital had given me 3 epinephrine injections and after the third injection we were leaving and I passed out and turned blue and all vital signs slowed down. The doctors told me at that time to never have anything that has epinephrine in it.

  9. I’ve been having an allergic reaction to the lidocaine my dermatologist uses to numb moles before she removes them. I have melanoma and have to go every 4 months to have moles removed and tested and have developed a severe skin reaction to the injections. We tested this week a lidocaine injection without the epinephrine and I have had no reaction to the injection. If I’m not allergic to the epinephrine, then what am I allergic to?

    • And just another note, I am allergic to thimerosal, but she has assured me there are no preservatives in the lidocaine shots she has been using.

    • Kelly,
      You are most likely reacting to the metabisulfite which is a preservative used to preserve the epinephrine. It is not found in local anesthesia that does not have epinephrine. See this blog post on it:
      http://directionsindentistry.net/novocaine-allergy-part-ii-methylparaben-sulfites/
      Please note that I am not an allergist so I can’t tell you definitively. But sulfite sensitivity and/or sulfite allergies occur fairly frequently and matches your description. I would pose this question to your dermatologist and then ask to be referred to an allergist.

      • Thank you for your fast response! I will definitely take this information to my allergist and dermatologist for further investigation. Id like to narrow down what I’m allergic to, so I can be sure to avoid it.

  10. When your world goes dark, you break out in a sweat, you cannot breathe right,
    you know you are about to pass out, your heart is pounding and it happens more than one time from the same medication, then you are having an allergic reaction! Oxygen is given by the dentist and he is panicking also, so call it an “Anaphylactic shock” if you want to, but a reaction is a reaction and still dangerous for those who have it happen!

    • Cassey,

      What you are describing is very consistent with vasovagal syncoope (more commonly known as fainting), especially if it is happening at the dentist.

      You may have missed the point of this article. An adverse event to a local anesthetic injection does not mean you are allergic to it.

  11. I understand why you are making a distinction between adverse reaction and allergic reaction, however, if the adverse reaction includes your body flooding itself with histamine, isn’t that what happens with an allergy? I have such an adverse reaction to epinephrine and norepinephrine that I am unable to naturally “come down” from the adrenaline and histamine surge without medical intervention. The same thing happens if I take antihistamines such as Benadryl. It’s like it triggers my body to keep pumping out adrenaline until it’s gone and I’m almost dead. It takes months to recover. At first I become out of control like that character in the movie The Mask, where the guy suddenly becomes superhumanly manic and says, “somebody stop me.” The adrenaline rush has gone on for days until taken to the emergency room and given some sort of “antidote”. I also at the same time have huge amounts of histamine causing severe swelling and hives that do not even respond to steroids. I am in my late 40’s and this began happening when I was a toddler and had novocaine after falling and breaking my front teeth. I can take sulfa drugs and consume sulfites with no problems, so I’m sure it’s not a reaction to that. I don’t remember what the “antidote” was because I was so young. I just know I cannot have epinephrine/norepinephrine and many antihistamines without a severe reaction that requires hospitalization. My grandfather is a doctor and shared an office with a dentist, his best friend, and this was drilled into me my whole life – “do not let anyone administer that to you – it could kill you.” As an adult living across the country from family, this happened a few times because no one believed me and thought I would never know the difference if they gave it to me. I was living in a small town and the hospital wouldn’t even admit me again for anything after it happened the first time. I think they were worried I was going to sue them. I moved. Oh well, that is my experience with epinephrine.

    • Amy,

      I can sympathize with your experience. But as I am sure you are aware, it is not typical.

      As you are already aware, your body, along with mine, naturally produces epinephrine and histamine. So the question is how/why does exogenous epinephrine provoke such a reaction? And even more importantly, is this an allergic reaction? As you are also likely aware, there are four type of allergic reactions (Types I through IV). They all must meet specific criteria. A release of histamine does not necessarily mean you are experiencing an allergic reaction.

      I don’t have an answer for why that happened to you. But I do have a stack of medical textbooks and the reasoning to conclude that you can’t be allergic to something that your body is producing on a continual basis.

    • Do you know what antidote was given to you, I had an epinephrine shot 3 days at the dentist and my heart feels like its going to explode with very little activity. I have chest pain and tightness. I went to the doctor and she said that it should only take a day or two to go away.

  12. George Mercado says:

    I had an allergic reaction to a food I had eaten I rushed to the ER and was given a shot of epinephrine to counter the allergic reaction to only end up with hives and a severe itch all over my body if the body isn’t allergic to epinephrine it sure is allergic to the preservatives in the epinephrine I was told by the ER doctor that I was allergic to epinephrine .

  13. Hello,
    Today after being given 3 carpules of anesthetic with Epi my hands and nail beds turned blue. I felt fine but when a pulse ox was applied I was reading at 94% for about 30 minutes. I was given Benadryl and my o2 saturation went up to 98%. I have no underlying medical issues. Could it be that I am allergic to the anesthetic itself instead of the Epi? I usually get sick to my stomach but never had this reaction.

  14. I am sorry but I don’t agree with the statement that it’s impossible to be allergic to something your own body produces naturally. In your body, what your body produces, IS natural. So fine, the statement works here.

    But the epinephrine that is injected via needle is synthetic is it not? Meaning your own body did not produce it naturally, but a lab did and although it mimics a body’s natural adrenaline it is not actually something your body produced naturally? Couldn’t this artificial “natural” form then possibly have the potential to cause allergic reaction?

    Yes reverse reactions are mistaken for allergies. But I do not see how it’s possible to say that with 100% certainty that an allergic response is not at all possible because something mimics something natural…

    • Hildie,
      The epinephrine injected is indeed produced in a lab so it would be synthetic. But it is exactly the same chemical that your body produces down to the last atom. What the injection DOES include is a preservative – that is KNOWN to occasionally produce either sensitivity or allergic reactions. I wrote about it here:
      http://directionsindentistry.net/novocaine-allergy-part-ii-methylparaben-sulfites/
      Water is basically two hydrogen atoms and one oxygen. I could make it in a lab, I could take it from the ocean and remove all the salt. Or I could take my own urine, remove all the waste, and then drink it. In all 3 cases, the water came from different sources, but they will have the same effect… because they are all the same.
      I have an emergency kit in my office with an epi-pen. One for adults and one for kids. I could take both and inject them both into my thigh. Sure, my heart would race, and I would start to sweat. But that doesn’t mean I am allergic. Make sure you’re not confusing an allergy with an unexpected reaction.

      • For the last many years I have been treated by a wonderful dentist and given numbing medicine with epinephrine – I was not sure that that was what was in the numbing medicine since my records definitely show a strong sensitivity to the drug. My dentist was having trouble numbing a molar that needed to be capped, he thought and thus injected 4 separate doses of the mixed medicine. Immediately after the 4th injection my body started shaking, especially the r. arm was shaking out of control. The dentist sat with me for over 30 minutes and most of my body calmed down except for the violently shaking right arm. He didn’t know what to do and asked me what I wanted to do. I ended up going to the ER where my body went into an all-out violent shaking/rolling, causing me to loose consciousnesses. I was given a lot of benadryl through injection, hospitalized overnight and had the most severe headache for the next 6 days – that no medication would touch. Did I have reaction to the epinephrine or am I allergic to it? My foot doctor and dermatologist stopped using numbing medicine with that drug in it since I had some minor reactions.

        • Dee,
          It is impossible to be allergic to epinephrine (remember – you and I both have epinephrine running through every square inch of our bodies right now).
          If you were given benadryl, that suggests the ER doc may have suspected an allergy (but remember benadryl can be given for other reasons too). Some individuals are allergic to the sulfite preservative used to preserve the epinephrine. Are you able to drink red wine? For more info, you can check out this post I wrote: http://directionsindentistry.net/novocaine-allergy-part-ii-methylparaben-sulfites/
          That is the best explanation I can give you given I was not there working on your case.

    • Kamille Amora says:

      Exactly.. Hildie, I was just gonna say some people are allergic to Insulin but our bodies produce that too..

      I was told by the emergency room in 2005 that I am allergic to Epinephrine after I came in from an allergic reaction when I stepped on a bee.. I did not start having seizure type reactions or go into Anaphylaxis shock until after I received an Epi pen.. They gave me something in an IV to reverse the medication and was then told I have a rare case and deathly allergic to Epinephrine. My next encounter was when I had my molar extracted from my mouth.. I have too much anxiety so I cashed out $600 to be put out under intravenous general anesthesia. I was dropped off for my procedure and when I woke up my family was around me crying so happy I woke up. Now I was high as hell and loopy and a lil incoherent till I got home and even fell asleep 4 times between the wheelchair and the truck but i remember everyone including a nurse saying shes alive and clapping and cheering when i opened my eyes, the dentist sitting there apologizing that he should have listened to me when I said I’m allergic to Epinephrine but didn’t believe it cause everyone produces it in their body.. Now I have a surgery scheduled for a lipo and brazilian butt lift and at my consultation the surgeon was in awe when I told him about those scary adventures and said that my healing procedure will take longer then most because after they remove your fat they use Epinephrine to when cleaning it and prepping it to transfer into your butt and it makes it so your not bruised as much. So he said I’m just gonna have to get it done without it and experience more bruising then usual which is completely fine by me.

      • Kamille,
        While I don’t doubt that you may have experienced an adverse reaction after the epi-pen, are you really sure you are “allergic to epinephrine”? Has an allergist tested you? Perhaps you were allergic or sensitive to the sulfites in the epi-pen. Many are. Or perhaps, as happens in many people, the epi-pen (which could have saved your life from anaphylaxis), produced unwanted effects that you, a family member, or ER Tech incorrectly described as an allergy.

      • Kamille, I was scheduled to have a Brazilian butt lift done on February 12,2015. I’m from CT and flew to Florida for my surgery but was told a day before that I could not have my surgery because I have raynauds, which already constricts blood vessels so using the epinephrine would’ve caused clots the surgeon said and he didn’t want to take the risk. Did you get your surgery? I’ve been very depressed about being turned away from a BBL.

  15. John Sanderson says:

    Adverse reaction or whatever you want to say. I experienced violent shaking and spasmodic responses to myself after receiving numbing shot in Dental chair. When I changed to new dentist few years later he tried tricking me and gave me a shot with epinephrine in it, same reaction, So I disagree with you, I experienced it.

    • John,
      You must not have read the post. I never said you can’t experience shaking or a racing heart. What I did say is that a RACING HEART AFTER A DENTAL INJECTION DOES NOT MEAN YOUR ARE ALLERGIC TO EPINEPHRINE. It is impossible to be allergic to epinephrine.

  16. Hello, I went to the dentist 3 days ago to have a filling. The dental hygenist injected the anesthesia (epinephrine). I wondered why she was doing it, I’ve always had the injections done by the dentist. I live in wy, is that legal? Well, very soon after she left I got an awful headache. My heart was pounding, i felt tightness in my chest. I tried lifting my head off the chair and i couldnt, it felt like it weighed 50 pounds. My neck was stiff and I just could not lift it up. I was afraid that I was going to have a heart attack.The dentist later came and began working on my teeth, i was feeling pain, so he had to inject me again! But used novacaine this time. I went home and went straight to lie down on my couch for atleast an hour. I just didnt feel good. This is so unlike me. I always have so much energy. Later that afternoon I went for a walk, i hadn’t walked for even 3 minutes and my heart was pounding and I was so out of breath. I ran 3 miles that morning and was fine. What is going on? I’m so afraid that damage has been done to my heart. It’s been 3 days since the injection and my heart pounds and hurts so easily over anything, just simply by walking. I’m really scared will i be like this forever?

  17. Hi,my name is Angela, I have been having a reaction to something when i recieve dental care. I had several extractions and suffered Blisters severely in the area of the injections , took a while to get better. Had more dental work and again everywhere I recieved a injection to numb me i got the blisters ,this has happened about 5 times,sense my 1st surgery and i j ave also developed red leasons after my second procedure. My regular dentist feels its a reaction to epinephrine. I dont know what it is execpt it gets worse every time. What is your openion on my reaction.

    • Angela,
      I was not there to observe this but I can think of 3 scenarios:
      1. An allergy to the topical ansethetic. Topical anesthetic is in the “ester” family and allergic reactions to this are more common. See this post for more details: http://directionsindentistry.net/novocaine-allergy-part-1-esters/
      2. An allergy to the sulfite preservative in the local anesthetic with epinephrine. See this post for details: http://directionsindentistry.net/novocaine-allergy-part-ii-methylparaben-sulfites/
      3. Local tissue necrosis due to the vasoconstrictor properties of the epinephrine. In some areas of the mouth, there is not ideal blood supply, and the epinephrine reduces the blood supply to the point where some of the tissue dies from lack of blood flow. I’ve seen this several times in my career.
      Those are my thoughts. The best way to avoid it is to ask your dentist for a local anesthetic that does not contain epinephrine… and also have him/her skip the topical too.

  18. Mark Belton says:

    Thanks so much for the informative website and for taking the time to do it. Yes, I’m one of those who has a very “adverse reaction” to epinephrine in Dental injections. Found out twice the hard way. Now, if one Googles anything like: “How long does epinephrine stay in the blood after dental work”, you’ll get a number of hits, people asking that question, but NO authoritative, factual answer. It would seem that there is a number of hours, days, ?? Thanks for any objective facts.

    • Mark,

      Thanks for the comment. I am pleased that you are aware that your reactions, although unpleasant, are not allergic in origin.

      I am not a Ph.D. physiologist nor biochemist, which is probably what you need to get the most definitive answer. But I like exploring these topics, so my response will hopefully be almost as good.

      To answer your question, I will re-phrase it in to two parts. The first is “How long does the actual epinephrine chemical remain in your blood?” The second is “How long do the effects of the epinephrine persist?”

      To understand the distinction, I will offer this crude analogy:

      You drink 6 shots of whiskey with no water nor food. You get drunk and then pass out. You wake up 8 hours later. You are no longer drunk, but you are hungover. In this case, the alcohol is no longer in your system – you would pass a breathalyzer if administered – but you are still feeling the adverse effects of the alcohol. That hangover can/will last for several hours more after all the alcohol is no longer in your system.

      Epinephrine is metabolized quite rapidly. In looking at this source out of Finland (http://www.acutetox.eu/pdf_human_short/96-Epinephrine%20revised.pdf), epinephrine administered to a human has a half life of approximately 8 minutes. So to generalize, in a little less than a half hour, the majority of the epinephrine has been metabolized, and cannot exert any additional effects.

      So then how long after will epinephrine continue to exert its effects – even after it is no longer present? That is a complicated question with many factors – your weight, the dose, the capacity of your liver, the site of administration, the route of administration, and probably 20 others. I can’t possibly list all of them. But, based on my knowledge – as a dentist who took advanced physiology classes years ago – the effects can persist for hours.

      I’m not sure if this response has helped you – but it certainly let you know that this is a complicated question with a very long answer!

  19. I have what my doctor diagnosed as a “sensitivity” to adrenaline, and the side-effects are constantly. Any time I have an adrenaline-rush, the resulting side-effects include tachycardia, hyperventilation, vertigo, nausea, and an instant migraine.

    I also have an allergy to the preservative used in local-anesthetics, with symptoms including swelling of the throat and sinuses, blood-shot eyes, a rash (sometimes causing tiny blisters and bleeding) around my mouth, on my tongue, and down my throat, and lethargy.

    At the same time, I’m a highly-allergic type (Latex, Penicillin and its derivatives, Doxycycline, Meperidine, Buspirone, Sulfur *and* Sulfa, all fruits/vegetables in the Belladonna family, mushrooms, caraway and fennel, etc), something which some doctors have tried to blame on the colour of my hair (redhead). lol

    As for the “impossibility” of being allergic to something your body creates, I’d have to disagree. What of the patients who are allergic to their own hair (and I know a few), their own sweat, water in any form, nickel allergies, etc? Rather than stating that it’s “impossible”, I’d be more inclined to say that an allergy to adrenaline was rare.

    • Sarah,

      Your response is a good reminder of why I wrote this piece.

      I am glad you are able to differentiate between “sensitivity” and “allergic”. Many people mix these up, or just assume that because something unexpected happened after they took a medication or ate something new that they must be allergic.

      Some people are sensitive to the sulfite preservative used to preserve epinephrine in local anesthesia injections. They then assume they are allergic to the epinephrine. This is obviously not true. If you want more info on this I wrote about it here: http://directionsindentistry.net/novocaine-allergy-part-ii-methylparaben-sulfites/

      Your last paragraph makes very little sense and contains a lot of inaccurate statements. Allergic to water? You are aware that approximately 60% of your weight is water? How can you be allergic to water? Nickel? Of course there are nickel allergies. But your body doesn’t produce it. You then conclude, with no supporting evidence, that epinephrine allergies are possible.

      I would love to see an article in a peer reviewed scientific journal that confirms your conclusion. Until then, I’ll rely on the multiple textbooks sitting next to me as I write this which state an allergy to epinephrine is impossible.

  20. Marie Bach says:

    Today I went to Orthodontist for root canal and I end up in the ER . Now I ask you your opinion because i have informed him about my reaction to epinephrine 2 weeks ago when he did one of the two needed root canals. The first he did 2 weeks ago he assured me that he will be very gentle and careful with epinephrine and I will be just fine, he was right. I like this orthodontist, but today he was not being careful and there I was on the chair having tremors and spasms so strong that he put automatic defibrillator on me. Things continued to get worse to where he called 911. What causes me to have a reaction at one time and not at another….could it be that if the injection is done slowly with lapse of time between them can change the reaction of the epi in me?

    • Marie,
      That is unfortunate what happened to you. It sounds like a lot went on. And based on your description, I can tell there are a lot of details that you aren’t including (probably because you don’t know them). What anesthetic was used? Was it an AED placed on you (unlikely – you really only place an AED if the person is unresponsive) or an EKG or simply a pulse oximeter? I can’t possibly know what occurred. Did you ask the provider what he thinks what happened? But what I can say for sure is that it has nothing to do with an allergy to epinephrine.

  21. Liz Fischer says:

    Here I am to bust your explanation of how no one can be allergic to epinephrine. I am in fact allergic to it; as in aniphalatic. What everyone seems to forget when they deny people’s claims of an allergy due to the fact that the human body produces this hormone is the fact that epinephrine/adrenaline when given in a injection is not sourced from the human body. It is in fact sourced from mammals; my research shows mostly cow or sheep, or is synthesized from other hormones sourced from mammals. Therefore a severe allergy to the source mammal can indeed lead to an allergy to epinephrine. I was diagnosed as a child after the hospital gave me a epi shot to help improve my breathing after an asthma attack and went into shock. I agree that this allergy is extremely rare and that most people would only have a sensitivity and not a true allergy, however to discount this allergy does those who suffer with it a great disservice.

    • Liz,
      Thanks for your comment. Your post contains several unclear and questionable assertions. Can you please clear these up:
      1. Epinephrine was first synthesized in a lab in 1904. Before the growth of the pharmaceutical industry, epinephrine was obtained from farm animals. This is true. But in post WW II America, with the boom of the drug industry, you are claiming that epinephrine being used in medical and dental settings was still being obtained from farm animals? What year was your injection done? Do you have any documentation to support your claim of animal sources in post WW II Amercia?
      2. Your assertion is unclear as to what you are actually allergic to. Bovine proteins remaining after the epinephrine was obtained from cows? Other impurities? Bovine epinephrine itself? The epinephrine your adrenal medulla releases?
      3. Is there a structural difference between bovine epinephrine and human epinephrine?
      4. Lastly, can you provide a link to support your claim of this allergy? Please note the link should come from a reputable source, not someone who simply claims they had an allergic reaction 30 years ago but offers no explanation…

  22. I think I will trust the program director of the Family Health Residency over your statements. I was having skin tags removed and he had Epi added to the numbing agent. Instantly I began having severe shock reactions and when the small amount of Epi had been processed through my system enough for me to regain consciousness they were preparing to insert a breathing tube and use an Embu bag to keep me breathing.

    • Charles,

      You comment is confusing.

      You imply that you believe you are allergic to epinephrine but then you indicate you had a “shock” reaction. What type of shock reaction? Cardiogenic? Hypovolemic? An allergic reaction is distinctly different than a shock reaction.

      If you do believe you are allergic, were you told specifically it was the epinephrine? Are you aware that a typical local anesthetic injection with epinephrine given in a hospital setting contains two components that can provoke allergic and/or sensitivity reactions? Those are methylparaben and bisulfite. How do you know the allergy was from the epi and not one of those components? Was the “allergy” confirmed by an allergist?

      Remember, an unexpected or adverse reaction that occurs after an injection does not mean you are allergic to it.

  23. With sneezing, and swollen lip, it’s an allergic reaction. The hyperventilating may be an adverse reaction. My son had all of these symptoms. Guess he had both, (adverse reaction and an allergic reaction.)

    • Bobbie,

      You are correct in stating that swelling is a finding in an allergic reaction. However, swelling is seen in many other situations such as trauma.

      The number one reason for a swollen lip in a child after a dental visit is trauma from biting him/herself while numb. Many kids – and even some teenagers – will bite their lip while numb – because they can’t feel it – and then within hours have significant swelling.

      Did you follow up with the dentist to get his/her input?

  24. Dental Mythbuster #10 is a marvelous blog and great eyeopener. I’m 73 yrs old, in relative good health, no serious (life threatening) medical conditions or disease. I do have SVT – Supra Ventricular Tachycardia – diagnosed by a leading Philadelphia cardiac arrhythmia specialist after doing an electro physiology study on me, mainly to rule out WPW which he and his team were able to do. This study was done in 1990, and afterwards the doctor told me: “This condition is not going to kill you. It’s what we call a nuisance disorder”. He prescribed Propranaolol on an “as needed” basis. He also gave me a copy of the letter he wrote to the cardiologist who sent me to him for evaluation. This is where my epinephrine story begins. In the letter he explains that during the study, in order to throw me into an SVT (after the electrical introduction of extra beats failed), I was given a shot of epinephrine which did the trick nicely. Please understand, I don’t have the letter with me as I write this, so the drug or agent they used to instigate the tachycardia may have been one with a similar name and having the same properties as epinephrine. At any rate, (npi), since the development of SVT, I have also developed chronic anxiety and panic disorder. A visit to the dentist has always been an anxiety provoking experience for me, and following the knowledge that a panic attack or an SVT episode might occur in the dental chair initiated by epinephrine in the numbing agent, made going to the dentist an agony for me. After having a very nasty and humiliating panic attack at the dentist; sobbing, ranting, pacing, and other similar but not so severe dental chair angst experiences post injection, I began telling dentists “No epi for me. I’m allergic.” This worked for years with no argument from any of the dentists I went to. The epi hit the fan a couple months ago when I was sent to an oral surgeon by my regular dentist to have a molar pulled. The “no epi for me” didn’t go over so well. He refused to work on me until he spoke with my primary physician – all because I used the wrong language. I told them I was allergic to epinephrine instead of saying “I have an adverse reaction to epinephrine.” The oral surgeon wanted a letter from my primary doc. My primary doc wanted to see me first before writing the letter. I took my old worn copy of the letter written by the arrhythmia specialist with me to show my doctor the mention of epinephrine as a chemical trigger for SVT. He wrote the letter to the oral surgeon explaining I was not allergic but had an adverse reaction to epi. I still have my bad molar and a bill from the surgeon who wants me to pay for his lack of understanding. He, being a dental surgeon, should have known what I know now from reading your blog. I don’t have dental insurance, so $95.00 is a big deal to me. Sure, I can scrape it up, but I resent having to pay him for not knowing something he should have known, something any dental surgeon should know. He wasted my time that day. He should pay me for my time and my having to go to my primary doctor to learn the difference between allergy and adverse reaction. I tweeted and pinned this blog. Thanks Dr. Nick

  25. I had a seizure at my dentist office. I don’t remember very much but I do remember having a crushing feeling in my chest when I woke up. I was decorated. I also remember a feeling of doom. I was 32 at the time. The dentist is the one that refuses to give me epi. Says that was the cause of it. He injected me and within seconds I was seizing. It took me 2hrs being in the hospital before I was at normal state again. Adverse reaction or allergic?? Sounds like there are more than just me that have had issues and maybe instead of dismissing it as not possible maybe it needs to be looked at. Does it come from animals? any synthetic parts to the epi? I don’t know these questions all I know is it would be nice to find a reason why it happens.

    • Mandy,

      I am sorry to hear that you had a bad experience like you describe.

      You are making a giant leap to question that are allergic to epinephrine. The key point of this post is that just because an unexpected or adverse reaction occurs, it does not mean you are allergic to it.

      You mention if it is animal sourced. And that is a good question. For example, many people are/were allergic to animal sourced insulin. The key is that it was a different molecule all together. Epinephrine is a much more simple molecule than insulin and is synthesized quite easily in a lab. So the epi in the dental injection is the same as what is running through your body.

      So what caused your unpexpected reaction? Possibly one of two preservatives in the injection (see here: http://directionsindentistry.net/novocaine-allergy-part-ii-methylparaben-sulfites/)? Unexpected vasoconstriction leading to temporary loss of blood flow to certain areas? Psychosomatic? I don’t really know.

      But is impossible to be allergic to epinephrine. See this follow-up post I did for more info: http://directionsindentistry.net/more-on-fabled-epinephrine-allergy/

  26. Thanks Doc! Wow, I was a believer that I was allergic! Your articles have been a great help to me, thank you!

  27. It really is incredible how pompous ignorant people can be. That some people think they are dangerously allergic to epi….
    Better not watch any scary movies, folks! They will literally scare you to death.

  28. When I had knee surgery, they used epinephrine to control the bleeding during the operation (I was put under general anesthesia). They attempted several times to use the epi, but each time they did, they could not keep my heart rate at an acceptable rate. When I came to, I had heart monitor pads all over my chest and the doctor informed me that my heart raced much higher than they care to see in a hospital. He informed me that I should let future doctors know that I have an allergic reaction (his words) to epi.

    After reading your article, I suppose that he was implying an ‘adverse’ reaction. either way, I have found that some medical offices prefer the use of “allergic” and others prefer “adverse”. Nonetheless, I avoid epinephrine by alerting my physicians to my past issues.

    • Chad,
      Thanks for the honest comment.
      What you are recounting is something that physicians and dentists struggle with. Pardon my colloquial language, but sometimes we have to “dumb things down” a bit so that patients will understand and remember. If I were to give a 5 minute detailed explanation to patients on issues like this, most of them would tune me out after 30 seconds and then we’re wasting everyone’s time.
      One of the effects of epi is that is makes your heart race. Hence the adrenaline rush that occurs that results in your heart racing. As a medical professional, sometimes you want that effect, and other times you don’t. So what you experienced in surgery was simply an unwanted side effect of the epi. You are not allergic to it.
      Your MD – I can’t speak for him – but his choice of the word allergic – when you are clearly not allergic to epi – may have been an attempt to get you to remember it. Rather than giving you a long explanation – which you then might forget – it was likely easier for him to say “you’re allergic.”
      On the plus side, you certainly remember that you had a bad reaction. On the negative side, there are people out there who are now convinced they are allergic to epinephrine – when they’re not. And that is why this article was written.
      Thanks again for the comment and your understanding/acceptance of allergic vs. adverse.

  29. I don’t seem to heal as quickly, when I have had a dental procedure using epinephrine, My previous (retired ) dentist took my request, and didn’t use it, and I healed quickly, and I had to have a lot of dental work done all in one day.It has been 3 weeks now since I have had dental work done, and I still have a lot of swelling, I don’t believe that it is the dentist that I have, I believe that it is the epinephrine

    • Jeannie,
      Delayed healing from any medical or dental procedure can be due to a myriad of factors including diet, certain anatomical considerations, systemic diseases such as Diabetes, skill of the practitioner doing the procedure, and MANY other variables. Generalizing and saying your experience is due to epinephrine is a bit short sighted. And delayed healing doesn’t mean you’re allergic to epinephrine either!

  30. In my opinion a doctor or other medical person may tell patients to warn other doctors they are allergic to a drug because it is easier than explaining the various details. \

    Anyway, thanks for this helpful article. I just had a strong reaction to a numbing drug at the dentist’s. I have never had any bad reaction before, and I have had many of these shots.

    The dentist gave me just 1 shot (I usually get 3, so I wondered about that), raised my chair up as usual so I could wait comfortably until the shot kicked in. I usually read, but my heart pounded very hard and out of rhythm, I felt like I wasn’t getting any oxygen from the air (I could breathe but it wasn’t doing me any good), and I started to faint. I quickly told the assistant to lower my chair back down; she did, and my heart rate went back to normal. I sat up, drank some water and saw my right hand shaking but knew I was gong to be fine at that point.

    Thanks for your help. I may ask for an alternative. It is so surprising to have a reaction after all these years of easy Novocain.

    • BTW, I had trouble with my heart, dizziness, and breathing for 3 days later. On day three I was having an all-day migraine and didn’t want to take Excedrin with my other symptoms. I used a Digital Massage Therapy Machine (where you put 2 electrodes in key positions on your body for pain management). I used it all day because it relieved the pain, and I could function again. Anyway, when the headache left, so did the heart pounding as well as all the other symptoms. Maybe it was just a coincidence, but I thought I’d mention it in case it could help someone else.

    • Sandy,
      I was not there to observe what happened. But based on your description, I bet that some epinephrine got into the bloodstream (this can happen more often than you think) which then led to a racing heart. That then made you very nervous causing a vasovagal type reaction.

      What I know for sure is you are NOT allergic to epinephrine.

      To your other point, I do agree that sometimes a medical professional may “bend the truth” and state you are allergic to something because it will be easier for the patient to remember. I think a lot of the confusion I see about allergies to epinephrine may originate from this.

      • Sandy Holliday says:

        Thank you so much for your help. I’m assuming it was one-time reaction. Your myth buster advice is excellent.

  31. I am having a problem now. I had a very bad adverse reaction to epinephrine. I’m so afraid to let the dentist give it to me again today. I’m afraid my heart won’t be able to take it. So I had to go to the dentist today for a root canal. He was using Novocain but the tooth was so inflamed that the Novocain would not work so he had to stop. I did not get my root canal but now I was told to go see a oral surgeon and have the tooth pulled. Is there any other drug out there we can use instead of epinephrine. And is there a way to administer epinephrine where it does not go into your blood stream. I ask because I had dental work done before and never experience this sensitivity to it before. Is there a way to give it to a patient so it does not go into their blood stream????

    • Sharon,
      Based on what you’re describing, it appears that the tooth was so inflamed, that despite all the local anesthetic you were given, you were not able to get numb. That will happen periodically and is not specific to you. You probably also felt some of the epinephrine that is included in the local anesthetic. That happens periodically and is not specific to you either.
      Unfortunately, the oral cavity is very vascular. There is no way to guarantee that some of the epinephrine in the local anesthetic will not enter the bloodstream. Using local without epi could be done but that is less effective than local with epi.
      The oral surgeon, depending upon his/her training and facility, could give you general anesthesia, and thus avoid having to do local entirely. You could discuss that with him/her.

  32. Janet-Lee Levinson MBA, MHSM says:

    But one CAN be allergic to the preservative that sustains the epi in lidocaine, thus carbocaine. Rare but existant

  33. Thanks for the great site! I am not disabused of the mistaken belief that dentists use “Novocain”.

    I also heard a rumor that the “Novocain” (Really Lidocain or others) that dentists use contains epinephrine – your site also confirmed this (and gave a very clear explanation of the “why”)

    Now my question lead-in: I had a bridge replaced yesterday and was given quite a bit of Lidocain (I assume, I didn’t ask) including some injections to reduce a really bad gag reflex. The dentist and his assistant determined I wasn’t numb enough and gave me even more. (Not complaining – numb is good!) I also had Nitrous Oxide for the first time and eagerly accepted my dentist’s offer. (I was a basket case – first major work in many years). Everything went fine and I;m awaiting the lab to deliver my new bridge.

    The real question is that late yesterday and again today, I have some pretty intense upper chest, neck, and shoulder pain and some neck stiffness. Could this be related to the Lidocain or Nitrous? I don’t recall any other injury or stress that could explain this pain. I suppose it could also be that I was so tense that the pain is a result of my own muscle tension. Any ideas?

    • (That’s “now disabused” – NOT “Not disabused”. Measure twice, cut once!)

    • Val,
      It’s hard to tell without seeing you but most likely the pain you experienced in muscular in origin, most likely from the stress. Especially in a longer procedure such as a bridge, where you may have been in the chair for 2 hours or more. Clenching and using those muscles in that manner could easily explain the pain, and again is the most likely explanation.

  34. Kathryn Cox says:

    Thank you for this article. Although I already knew that one is not having an allergy crisis with epi, your words confirmed what I already suspected. Everyone’s body reacts differently to any type of substance. Comforting to know.

    Issue with one tiny thing.
    “Hey, doc….” should be “Dr. Friendly Dentist, please use epi free….” Just saying we should be polite and respectful. Good personal skills will melt any professionals heart.

    • Kathryn,
      Thanks for the post. I will consider changing the wording.
      Mutual respect of both parties nearly always leads to ideal outcomes. A respect of the patient’s concerns and desires paired with a respect of the provider’s expertise and experience is the best recipe for success. You are right 100%.

  35. LuAnn Kendrick says:

    My reaction to epinephrine is paralysis of my body. I had pneumonia about 30 years ago and was in the hospital. They came around to give me some kind of medicine in a vapor placing a mask over my mouth. Within minutes my hands started to become paralyzed. They quickly took off the mask and told me to never allow anyone to give me epinephrine. From that time on I told every dentist and ever doctor and no one gave me any epinephrine. Well, until a new dentist I was seeing didn’t believe me and convinced me to let him use it. Within a very short time my entire body was paralyzed! It probably only last 15 minutes. However I was left feeling weak but at least able to finally speak. I told him he might as well go ahead and do the necessary work as he had already deadened the area. Throughout his work my arms would feel like an electrical shock had hit them and they both, or one at a time would jerk and fly up into the air.
    Okay, so that was about 3 years ago. Two days ago I had foot surgery and even though everyone knew of my “allergy” to epinephrine it somehow got put into the ankle block. I was in recovery for over 2 1/2 hours! Most of the time was spent in complete paralysis! I could hear every word that was being spoken…”She seems to be catatonic!” “No, I think she may have had a stroke!” “Maybe she had a seizure”. After finally being released from this terrible state I felt so weak I could hardly move…but at least I could move if I wanted to. I want medical professionals, including dentists, to understand that it is a very dangerous thing to dismiss a patient’s request that they are NOT to receive epinephrine!

    • LuAnn,

      I am sorry to hear about your experiences.

      If you read the article and interpreted it as me dismissing a patient’s requests, then you need to re-read it.

      Keep in mind that when a person is under stress for a medical or dental procedure, their own body releases FAR MORE epinephrine than what is contained in the injection. That explains the racing heart and elevated blood pressure before we even start. I’ve seen patients with similar symptoms after receiving injections of local without epi.

      I am glad you put “allergy” in quotations – that implies you know you are not allergic, but you rather you experienced unwanted side effects. Just like opioids can cause constipation and nausea, statins can cause insomnia, and ACE inhibitors can cause a chronic cough, epinephrine has its own set of adverse effects.

  36. Curtis Kendrick says:

    ad hominem attack deleted. My mom is highly allergic to epinephrine. She has been giving it a few times and has went totally paralyzed for 3-4 hours. Right now a so called Dr give her an epinephrine block after she told them she was highly allergic. He didn’t think so. He give it to her anyway this was a week ago. She went paralyzed they pumped her full of all kinds of meds. She is still messed up from it her body is shaking and everything. So don’t say you can’t be allergic to it.

    • I deleted your personal attack against me.

      You need to re-read the article.

      I’ll reiterate:

      An adverse drug event does not mean you are allergic to the medication.

      I’ll say it again:

      An adverse drug event does not mean you are allergic to the medication.

      If you develop an ulcer after taking aspirin, it does not mean you are allergic to it. It means you experienced an adverse drug event.

      If you develop weakness and low blood sugar after taking insulin, it does not mean you are allergic to it. It means you experienced an adverse drug event.

      If you develop a UTI after taking an antibiotic, it does not mean you are allergic to it. It means you experienced an adverse drug event.

      If your heart races after receiving an injection that contains epinephrine, it does not mean you are allergic to it. It means you experienced an adverse drug event.

      An allergy is a very specific immune response. Perhaps you should research what an allergy is before you start insulting people.

      In the time it took me to respond to your malicious comment, your mother’s own body has released far more epinephrine than was allegedly given to her. Give that some thought and maybe you’ll change your thinking.

  37. Philomena says:

    When I received my injections of epinephrine to have my wisdom toath extracted I started to have the shakes when I was done. My dentist explained that this sometime’s happens to patients . She had me sit there for 20 minutes until the shakes left me.

    • The “shakes” you describe are likely from epinephrine. The continued shakes were likely from your OWN epinephrine that your body is releasing. In stressful situations – i.e. a tooth extraction – your body releases epinephrine. That amount is usually far greater than the usual .036 mg that is contained in each dental injection.

      And it should be pretty clear that your reaction is not allergic in origin.

  38. Kathleen says:

    Question. If you had an adverse reaction, I had a seizure and my daughter had necropsy we were both told separately decades apart that we were allergic to epinephrine. Does this mean we are allergic or would have an adverse reaction to an epi-pen?

    • Kathleen,

      I wasn’t there to observe you or your daughter’s reactions. Note that some health care providers tell patients the wrong things; other times they will simplify issues into terms they feel patients will understand and remember.

      Seizures can occur for a variety of reasons. I can’t possibly know why you experienced that, but concluding that epinephrine caused the seizure, and then concluding that you must be allergic to epinephrine is a bit of stretch.

      Regarding your daughter, the term “necropsy” is simply a synonym of autopsy. I doubt that actually happened (that means your daughter passed way and then had an autopsy performed). Perhaps you mean necrosis? If epinephrine is given too quickly or in the wrong area, it can cut off blood flow locally, leading to a localized area of necrosis. This is not allergic in origin – rather it is the normal effect of the drug if/when it is given in a manner it was not intended.

  39. I just got home from a 6 hour ER trip after trying to get 2 cavities filled by the dentist in the top/front of my mouth. I’m known as a slow metabolizer and extremely sensitive to most medications. I’ve never had Epinephrine that I know of, so was surprised to start shaking violently, felt like I couldn’t breathe, felt like an elephant was sitting on my chest, became nauseated, dizzy and developed blurred vision. My Dentist was shocked and said she had never seen a reaction like this before. While I agree that it wasn’t an allergic reaction – it sure was an ADVERSE REACTION! I’ve never had a panic attack before, but if what I experienced is anything like what people go through, I have nothing but compassion for them. I thought I was having a heart attack. Scared the snot out of me!

  40. Linda Coney says:

    I have a question about preservative-free local anesthetics.I have had three terrifying events in the dentist’s chair following injection of local anesthetics. I also collapsed in my doctor’s office after being injected with vitamin C that had preservative in it. I had done fine prior to that with vitamin C injections, but when my doctor switched to a multi-dose vial with preservative in it, I had a severe adverse reaction to it. Does carbocaine come in a form that is totally free of preservatives? Are there any local anesthetics that are completely preservative free?

  41. Hello,
    I found this post while searching around, trying to discover if shaking approximately 36 hours after injections of one of the longer-lasting numbing agents (I don’t know which one) is normal, or a cause for concern. The article title interested me, so I read it.

    After reading about 20 of the comments, I have concluded you are one of the most patient people on Earth. I just wanted to commend your patience, dedication, and ability to admit when something is not your speciality.

  42. I just love that a bonafide dentist is taking time to address dental anesthesia questions. Thank you so, so much!

    I never had a problem with dental anesthesia until a procedure 25 yrs ago that involved a palatal ridge injection for a bridge prep. I had no clue how sensitive that spot is! The numbness then spread immediately and profoundly and one eye was blurry and even my eyebrow was a bit numb. The dentist left the room and I had one of the worst panic attacks I’d ever had and I was alone during it. By the time the dentist came back 10 min later the P.A. had finally subsided so he didn’t see it personally and I felt too drained able to tell him until the next visit. What I learned from my research into panic attacks and dental procedures, aside from experiencing how painful palatal ridge injections are and that epi is in many oral anesthetics, is that it’s important to have a small paper bag available to breathe into for 2 – 3 min in case anxiety starts. The feeling that the panic will never end is worse than anything else. I knew it was a panic attack, but it was intense and I couldn’t speak to get help. So please help get the word out to dentists and on your blog that a simple tool (paper bag) can bring relief to raise the CO2 levels and that an assistant should at least be there at the ready just in case.

    I’ve had every dentist since use Carbocaine, although last year my dentist tried a different anesthetic on me (maybe it was Articaine?) and I had no reaction so I have her use that now since the Carbocaine wasn’t lasting long enough in my crown procedures, causing me to have multiple injections and still some pain breakthrough. Just a little epi is really all I need.

    Knowledge is power when it comes to learning about our bodies. Knowing what to expect and how to handle a panic attack is so important–if it isn’t, it should be considered a core part of dental school education, since it appears many people are affected. Again, thank you for taking the time!! Much appreciated!

    • Natalie,

      That sounds like quite an experience there. Palatal injections are quite painful and can elicit many different responses.

      Your head – including the oral cavity – is the most densely vascularized area of your entire body. This means there are tons of blood vessels running through the tissue. As dentists, we want the substances to stay where we inject them, but it is common for the substances (local anesthetic, epinephrine) to get taken into a blood vessel and brought elsewhere. It sounds like that happened to you.

      The most common “medical emergency” that occurs in a dental office is syncope. Syncope can best be described as fainting or near fainting. A panic attack that you described has many facets to it, but it seems like hyperventilation was what you experienced most. The breathing into a paper bag technique is most often recommended, although recent recommendations have switched to cupping your hands and breathing into them.

      As an FYI, articaine, at least in the U.S., is only available with epinephrine in it (either as 1:100,000 or 1:200,000). So if you’ve had articaine recently it had to have contained epinephrine (assuming you live in the U.S.).

      At any rate, it’s good that you emerged from that experience more knowledgeable and are still able to receive dental treatmetn.

      • Dear Dr.Nicholas,

        Once again, thank you for taking the time to help out people with allergy/reaction problems.
        Recently, I went to see an ophthalmologist due to a scratching feeling in my eye; ad a health problem myself, I knew it was not conjuntivitis.
        He did not care for my notes on reaction to sulfites, and prescribed antibiotic + steroid eye drops. I told him I could not have a steroid, and he said that “whatever goes in the eyes is not absorbed by the body, and he claimed to give this prescription to everyone”….Sad, and unfortunate to have this statement from a physician. I wish every physician would have your physiology knowledge.
        Thank you again for sharing it.
        M.C.

  43. Shana Lehrmann says:

    This is not a personal attack. Just an explanation of my unusual biochemistry.

    I have a severe sensitivity to benzene. It causes me to experience hives and difficulty breathing just like an allergic anaphylactic episode, but also causes my gums or nose to bleed for at least an hour a day over the course of a week. These reactions can occur anytime between 3 seconds and 3 days after exposure. The delay of hours or days before reaction made it particularly difficult to diagnose; an allergist didn’t figure it out, but my rheumatologist did from my severe reactions to all NSAIDs and the increasing reactions I had to most ingestible plants.

    As noted above in your molecular diagram of epinephrine, epi or adrenaline does contain benzene. When I experience acute stress to the point of an adrenaline surge, I do get hives, have trouble breathing, and get nose bleeds and/or bleeding gums. Benzene is also present in any of the “caine”s or toothpastes, so we have to use nitrous oxide for the insurmountably painful stuff and baking soda for cleanings. And before everything got switched a few years ago, I would need to send people searching through the facilities for non-latex gloves.

    When doctor or dentist offices have me fill out paperwork, the phrasing I almost always see is “Please list allergies.” As mentioned elsewhere above, it is really just a case of semantics. If the phrase “Please list dangerous medical reactions” was always used, which could thereby include allergies, sensitivities, and intolerances, and sufficient space was provided for the patient to explain such, it might make everything clearer for everyone.

    Although, several times at hospitals and in dental chairs, I have experienced accidents that endangered me because personnel forgot to read my chart. It isn’t a lot of fun to deliver a baby or recover from surgery or try to relax while somebody uses sharp hooks and dental floss at your sensitive gum line when you’ve been briefly exposed to penicillin or toothpaste before you were able to correct said personnel and you don’t know if the reaction is coming immediately or a couple of days later, but you know it is coming. So I, as I believe all patients should, have learned to have a conversation with any doctor, dentist, nurse, dental hygienist, etc who is going to treat me about my multiple chemical sensitivities, allergies and intolerances. It is time consuming, and for some can be frustrating, but it is better safe than sorry.

    Thank you for choosing to help your patients with alternatives, even if they get the semantics wrong or don’t have a moderate understanding of chemistry.

    • Shana,

      You certainly have had a long history with sensitivities to various substances and I’m glad you’ve gained some insight into it.

      I would caution you on making broad generalizations about “benzene”. I put benzene in quotes because benzene refers to only the C6H6 compound and is a known carcinogen. Many compounds contain that structure but it is not called benzene when it is part of a larger compound. Toluene is basically a C6H5 ring with a methyl group attached. It would be incorrect to call that benzene. I mention this partly due to semantics but also so you know. Anyone that told me they were sensitive to benzene I would look at weirdly because benzene in sufficient quantities will kill you.

      I also bring this up because there are many compounds in your body that contain this structure. You correctly point out epinephrine. Others include dopamine (a neurotransmitter) and T3 and T4 (thyroid hormones). And not to mention nearly all of the proteins in your body contain tyrosine and phenylalanine which also have this structure.

      So I caution you in stating something to the effect of “all compounds that contain a benzene ring will cause me allergic like symptoms” because that statement simply is not true, as you have dopamine, T3, and T4 running through your body with no apparent issues.

      I do appreciate your comments regarding paperwork and how to possibly change it to include more reactions other than allergic.

      • Janet Scott says:

        Hello. I’m allergic to adrenalin and anything ending with Caine. I asked my dentist what the difference between a severe allergic reaction is and an allergy. He told me there’s nothing, either can kill you. My symptoms started with a fast heart beat and slowly progressed to fits. I thought you couldn’t be allergic to something that your own body produces but it looks like I was wrong. From now on, I will go to the hospital 🙁

  44. Kathleen greene says:

    Why is it then I pass out when I have Epi in the novacaine but when it’s removed I don’t pass out and sweat. I work in health care and I am not afraid of having an injection. Why can’t I physically handle the injection with Epi?

    • I was not there to observe you “passing out and sweating”. But passing out and sweating are textbook symptoms of vasovagal syncope.

      Besides syncope, there are many other physiologic mechanisms to explain this unexpected reaction. But none of them are allergic in origin.

      In a stressful situation, your own body releases far more epinephrine than what is included in a typical dental injection (.018 mg).

  45. Whilst not allergic to epinephrine I definitely very sensitive to the naturally produced hormone. I am 52 and have travelled a great deal hence been in a few dangerous situations.It seems to take me a lot longer to calm down than most people after flight or fright response is induced. Therefore if I visit new dentist I always inform of my sensitivity to epinephrine.

  46. Brenda Alberino says:

    Thank you for the information. I’ve always had an adverse reaction to Novocain at the dentist or any other “Cain”… At first I though I was over reacting but then the following incidents also happened… when I had a injection to remove a tiny cyst and when I received a cortisone shot, my heart raced immediately and almost hurt ! When I asked each doc what was in the shots each had lidocaine in them. Even the tiny amount up front in the cortisone shot did it! So… the questions I have are “can the adverse reaction be life threatening” ? If I need a surgery is this something to note to surgeon?

    • Any adverse or unexpected reaction to a drug can be life threatening. It all depends on the dose, type of reaction, your underlying medical condition(s), availability of medical assistance, and many other factors. I think the big question here is WHY you are reacting this way. I wasn’t there to observe your responses but I can tell you that there could be many reasons, including psychosomatic ones, at play here.

  47. Jenn Lang says:

    Thank you so much, I’ve been using the term ‘sensitive’ to describe my problem.
    My Dentist used Nor. in desperation one day without telling me. Within two minutes maximum, my hands were badly shaking. and eventually my whole body began vibrating uncontrollably but I was fully cognizant. It lasted apx 30 min. Very disconcerting.
    Appreciate your explaination and personal input
    Sincerely,
    J Lang

  48. levon marcellus says:

    Thank you for informing me!!! My wife has been suffering a headache for 24 hrs after recent dental work. We are so happy to have found this myth busting series and to have been properly educated. Adverse v. allegic, epinephrine v. adrenaline, novocaine is not what was administered to her. Thank you!!

  49. Donald G Henry says:

    You provided nothing. Your reasoned away patients experiences with words. You’ve Busted nothing.
    If you patient discribed passing out on the table a pulse rate approx 40bpm and very low blood pressure. This has happened to me three times over the years. I always wake in the room with room full startled people. You are probably right it is probably not the epinephrine but something in the administered dose. I only repeat what the dentist told me to say the first time it happened. He said to say, ” NO EPIE” the rest of my life. The last two doctor were but out on the notion untill it happened just as before.

    • Donald,

      I am not sure you are aware of this or not, but your comment has proven the point of my original post 100%.

      You obviously experienced an unexpected reaction after being adminstered drugs where one of the drugs contained epinephrine.

      You have then assumed and concluded that you are “allergic” to epinephrine.

      Please read this carefully.

      Just beacause you experience an unexpected or undesirable reaction to a medication does not mean you are allergic to it.

      If you drink alcohol and then vomit, that does not mean you are allergic to it.
      If you take amoxicillin and get a yeast infection, it does not mean you are allergic to it.
      If you take clindamycin and then develop diarrhea, it does not mean you are allergic to it.
      If you take significant amounts of aspirin and develop a gastric ulcer, it does not mean you are allergic to it.
      If you take Vicodin and then become painfully constipated, it does not mean you are allergic to it.

      Did you see an allergist to confirm your “allergy”? Was a skin test done? Was bloodwork done measuring your IgE? How come the drug inserts for exogenous epinephrine do not include a warning of an allergic reaction to the epinephrine?

      Your response has proven nothing – other than reinforcing my point.

      I would suggest you google “vasovagal syncope”. This is the most common medical emergency that occurs in dental offices and your brief description of your incident suggests that’s what occured.

  50. That’s what it is!!! My reaction to the local anesthesia at the dentist was always feeling like I am going to faint, sweating, nausea… I doesn’t last long, but definitely not pleasant.Yet, I dreaded visiting my dentist. I never told him, thinking that it is an anxiety attack. That is what my friends told me. Now I know what to ask for.

  51. By the way, I also suffer from serotonin syndrome (proved). There is possible connection.

    • Elvira,
      If you suffer from serotonin syndrome then you must be taking at least one serotonergic medications. Those medications can interact with the epinephrine.

      Each and every case is different and there is no way I can possibly know your individual case.

      However, epinephrine interacting with a medication in a patient with Serotonin Syndrome does not mean you are allergic to the epinephrine. Remember, epinephrine is being produced and in your body as you read this. And you’re not suffering an allergic reaction now.

  52. Epinephrine allergy? The idea that epinephrine does not create an allergic reaction is probably true however the ingredients contained within are most certainly responsible. Adrenalin cannot be administered without the presence of lactose and I have an extreme allergy to lactose in particularly in unusual combinations. Milk for instance produces a minor chest reaction and over a period of time severe debilitating arthritis. Milk in scalped potatoes causes a severe reaction, yet without milk scalped potatoes are fine, I am 69 years old and believe me I have tested my ideas hundreds of times.

    • Gordon,

      You are 100% correct that some of the ingredients used in epinephrine formulations can provoke allergic-type reactions. For example, all the epinephrine used in dental local anesthesia contain some sort of sulfite as a preservative. Those sulfites can produce reactions in some individuals. None of the packaging I have read mentions anything about lactose being added. Do you have a source for that? Here is the prescribing info for an epinephrine auto-injector:

      http://www.epinephrineautoinject.com/pdf/Prescribing-Information.pdf

      • Hi: It is my understanding that some ingredients known as inactive ingredients are not listed in the packaging of these products. My reaction to dental freezing is consistent and clear and when a product is used without the presence of epinephrine I am fine. I react to cleaning fluids however they are NOT the culprit! They simply release, just as intended, allergens in my throat, nose, sinuses and lungs. My reaction is of coarse somewhat less pronounced during our cold, snowy Canadian winters when the presence of allergens are greatly diminished. There is an ongoing reluctance in the Medical Community to look beyond a product into combinations and catalysts. I am acutely aware of a number of variations since I have some very severe food, airborne and skin reactions that I have lived with for sixty nine years. Clinical testing does not work! How can you test a subject when you have no idea what releases, promotes or activates an allergen?

      • Hi Dr Calcatarra:
        Further to my statement earlier today: Coarse was used in the wrong context it should have been course.
        Since a very early age I have developed skin blisters from automotive brake fluid which apparently contains sulfites. I also react with extremely serious breathing difficulties to round up (glyphosate). I read in a pharmaceutical website (I don’t know which one) that many medications contain lactose most widely used in nasal spray. I have had constant infections and nasal congestion following their use until a pharmacist pointed out one that does not contain lactose and it worked fantastically. Maybe I am facing a double reaction?
        Thank you enormously for pointing the sulfite issue out to me at age 69 I learn every day!!

  53. Dr. Nicholas,
    Is there anything that can be used as an alternative to epinephrine for dental surgery? I have adverse reactions every time I have a dental procedure (shaking, sweating, pass out) that complicate and lengthen the procedure. My implant failed (just today..) so now I’m looking at having to go through 2 additional procedures (bone graft, implant) in the next year. Would love to avoid the whole passing out, bringing blood pressure back up to normal ordeal if possible.

    • Daisy,

      There are many local anesthetics that do not contain epinephrine. But have you discussed this with your dentist? The reason I am stating this is because the symptoms – passing out, sweating, low blood pressure – are all suggestive of vasovagal syncope – as opposed to the direct effects of the epinephrine.

      • Thanks for your reply! Yes, vasovagal sounds about right. I haven’t talked to my oral surgeon yet about trying another anesthetic. I didn’t realize there could be other possibilities for anesthetic before reading this post and comments. Definitely going to explore other options. I really dislike passing out.

  54. Sidney Foster says:

    OK, I understand the difference between allergy and adverse reaction. But since I have been diagnose with sinus tachycardia using epinephrine is not an option for me. Atenolol reacts to epinephrine, that it put me the hospital.

  55. Val Baugh says:

    Yes, I am hypersensitive to epinephrine even in the smallest amount that can be found in the eye drops used by an Ophthalmologist. One dentist who didn’t believe me regretted his use as he stood watch my whole body go into what looks like someone having a full on seizure. Yes there is a difference between an allergy and a sensitivity, but both events are unpleasant to experience. As to alternatives, I just elect to not have any form of injection at the dentist office. Even to having a root canal, drilling, and teeth pulled with out any medication. I would rather tolerate the pain than experience the frightening reaction my body has to epinephrine.

    • Val,

      A couple of things:

      1. I am glad you understand the difference between an allergy and being overly sensitive to the effects of a medication. There is a huge difference.
      2. Local anesthetics by themselves – without epi – can precipitate seizure-like symptoms. This is very rare and depends on many factors.
      3. I wasn’t there for your ophthamologist visit. The most common medication used for pupil dilation – which may or may not have been what was done to you – is not epinephrine. It is an anti-muscarinic agent tropicamide. Some formulations also contains phenylephrine which is a sympathomimetic – it acts in a similar way as epinephrine. Again, I wasn’t there, but don’t assume that the typical eye drops used for pupil dilation contain epineprhine – because they don’t, at least not in the U.S.
      4. Lastly, all dentists carry local anesthetic without epinephrine. That is always an option for you.

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