Differential Diagnosis Between Local Anesthetic Allergy and Systemic Toxicity Following Septanest Administration in Endodontic Treatment: A Case Report

Local anesthetic allergy, Local Anesthetic Systemic Toxicity (LAST), Septanest, Articaine, Endodontic treatment, Immunoglobulin E (IgE).

Si Dung Chu 1, 2, 3
MD, PhD in Cardiology, 1 Health Management
Training Institute, Hanoi University of Public
Health (HUPH); Pham Ngoc Thach General
Hospital, HUPH, Vietnam Ministry Of Health;
2Formerly Head of the Department of
Emergency resuscitation and Poisoning
Control, Hospital of Vietnam National
University (VNU), Hanoi, Vietnam; Email:
cds@huph.edu.vn,
sichu.bvbachmai@gmail.com.
ORCID: 0000-0001-7723-5893

Nga Thuy Thi Nguyen 1
Health Management Training Institute, Hanoi
University of Public Health (HUPH), Vietnam;

Ngoc Tuan Vo 1
Health Management Training Institute, Hanoi
University of Public Health (HUPH), Vietnam;

Tuong Van Phan 1
Health Management Training Institute, Hanoi
University of Public Health (HUPH), Vietnam;

Minh Thi Tran 3
Vietnam University of Traditional Medicine
(VUTM), Vietnam;

Linh Tran Pham 4
Vietnam National Heart Institute, Bach Mai
Hospital, Hanoi, Vietnam.

Received:19-06-2026
Revised:23-07-2026
Accepted: 27-07-2026

European Journal of Prosthodontics and Restorative Dentistry (2026) 34(7s), 42–46

Differential Diagnosis Between Local Anesthetic Allergy and Systemic Toxicity Following Septanest Administration in Endodontic Treatment: A Case Report

Local anesthesia is a fundamental technique in modern dentistry, but acute adverse reactions present a significant diagnostic challenge. While serious amide local anesthetic allergies are exceedingly rare, distinguishing between an IgE-mediated immune response (anaphylaxis) and Local Anesthetic Systemic Toxicity (LAST) is critical, as their pathophysiological mechanisms and emergency management protocols differ entirely. This case report describes a 38-year-old female patient who developed extensive bilateral facial erythema and severe pruritus, rapidly progressing to the neck, just 5 minutes after a 1.8 mL infiltration of Septanest (4.0% Articaine with 1:100,000 Epinephrine) for endodontic treatment. The patient remained conscious without respiratory distress, and hemodynamic parameters were stable (Blood Pressure: 128/78 mmHg). Retrospective laboratory analysis revealed a markedly elevated total IgE level (1314 IU/mL), confirming an acute IgE-mediated type I hypersensitivity reaction. The patient responded optimally to immediate discontinuation of the dental procedure, followed by administration of an antihistamine (Diphenhydramine) and a corticosteroid (Methylprednisolone), with full resolution of symptoms within 1 hour and 15 minutes. This case underscores the paramount importance of immediate clinical differentiation of adverse local anesthetic events. The predominant cutaneous symptoms and stable hemodynamics supported a diagnosis of Type I allergy over LAST. The successful management reinforces the need for astute clinical reasoning, adequate preoperative assessment, and constant emergency preparedness in the dental operatory.

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