A Case of Anaphylaxis to Patent Blue in a Patient with Sentinel Lymph Node Excision
In medicine, patent blue violet (PBV) is utilized for staining lymphatic vessels in sentinel lymph node (SLN) surgery. Moreover, PBV (also called E131 ) is used as food additive. We report on a 51-year-old non-atopic female with early breast cancer, who was scheduled for SLN excision and experienced an intra-operative anaphylactic reaction. In diagnostics the skin prick test (SPT) was positive to PBV. Hypersensitivity reactions to PBV can arise after the first exposure in surgery as sensitization may arise from either PBV (E131) in foods (i.e. in sweets or blue curacao) or from other structurally closely related triarylmethane dyes in objects of everyday life like textiles, detergents, paints, cold remedies and cosmetics. This article supports the necessity of an increased awareness of the possibility of anaphylactic reactions to PBV during SLN surgery, even if the patient never had contact to PBV before.
1. Sinclair DJ, Perera FA. Allergic reactions: following patent blue dye injection. Can Med Assoc J 1969;101(10):100-1.
2. Gonzalez-Estrada A, Pien LC, Zell K, Wang XF, Lang DM. Antibiotics are an important identifiable cause of perioperative anaphylaxis in the United States. J Allergy Clin Immunol Pract 2015; 3(1):101-5.
3. Mansouri R, Chicken DW, Kehtgar MR. Allergic reactions to patent blue dye. Surg Oncol 2006; 15(1):58
4. Krishna MT, York M, Chin T, Gnanakumaran G, Heslegrave J, Derbridge C, et al. Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom: aetiology and diagnostic performance of acute serum tryptase. Clin Exp Immunol 2014; 178(2):399-404.
5. Brenet O, Lalourcey L, Queinnec M, Dupoiron D, Jayr C, Rosay H, et al. Hypersensitivity reactions to Patent Blue V in breast cancer surgery: a prospective multicentre study. Acta Anaesthesiol Scand 2013; 57(1):106-11.
6. Beenen E, de Roy van Zuidewijn DB. Patients blue on patent blue: adverse reaction during four sentinel node procedures. Surg Oncol 2005; 14(4):151-4.
7. Hunting AS, Nopp A, Johansson SG, Andersen F, Wilhelmsen V, Guttormsen AB. Anaphylaxis to patent blue V. I. Clinical aspects. Allergy 2010; 65(1):117-23.
8. Haque RA, Wagner A, Whiskeen JA, Nasser SM, Ewan PW. Anaphylaxis to patent blue V: a case series and proposed diagnostic protocol. Allergy 2010; 65(3):396-400.
9. Mertes PM, Malinovsky JM, Mouton-Faivre C, Bonnet- Boyer MC, Benhaijoub A, Lavaud F, et al. Anaphylaxis o dyes during the perioperative period: reports of 14 clinical cases. J Allergy Clin Immunol 2008; 122(2):348-52
10. Wöhrl S, Focke M, Hinterhuber G, Stingl G, Binder M.Near fatal anaphylaxis to patent blue V. Br J Dermatol
11. Johansson SG, Nopp A, Oman H, Stahl-Skov P, Hunting AS, Guttormsen AB. Anaphylaxis to patent blue V. II. A
unique IgE-mediated reaction. Allergy 2010; 65(1):124-9.
12. Scherer K, Studer W, Figueiredo V, Bircher AJ.Anaphylaxis to isosulfan blue and cross-reactivity to patent blue V: case report and review of the nomenclature of vital blue dyes. Ann Allergy Asthma Immunol 2006;96(3):497-500.
13. Longnecker SM, Guzzardo MM, Van Voris LP. Life threatening anaphylaxis following subcutaneous administration of isosulfan blue 1%. Clin Pharm 1985;4(2):219-21
14. Forschner K, Kleine-Tebbe A, Zuberbier T, Worm M.Type I sensitization towards patent blue as a cause of anaphylaxis. Allergy 2003; 58(5):457–8.
15. Montgomery LL, Thorne AC, Van Zee KJ, Fey J, Heerdt AS, Gemignani M, et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anaesth Analg 2002; 95(2):385-8.
16. Nour A. Efficacy of methylene blue dye in localization of sentinel lymph node in breast cancer patients. Breast J 2004; 10(5):388-91.
|Issue||Vol 15, No 6 (2016)|
|Allergy Anaphylaxis Blue dye Breast cancer Patent blue violet Sentinel lymph node excision E131|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|