A 27-year-old woman with a history of Crohn's disease and an allergy to penicillin presented for routine restorative dental work. Xylotox E80A (3.6 mL of 2% lidocaine with 1:80,000 epinephrine) was given, and the dental work was completed uneventfully. Three months later she presented with acute pulpitis of a mandibular molar for which root canal therapy was indicated. At this time, 1.8 mL Xylotox E80A was given. Within 2 minutes, the patient experienced severe respiratory distress and the procedure was delayed for 5 days. In a fully equipped operating room, a subcutaneous test with Xylotox E80A was performed and acute bronchospasm resulted. This case report describes severe bronchospasm following the administration of lidocaine on two occasions.