Allergic reactions to isosulfan blue during sentinel node biopsy--a common event.
BACKGROUND
Sentinel lymph node (SLN) dissection in the management of high-risk melanoma and other cancers, such as breast cancer, has recently increased in use. The procedure identifies an SLN by intradermal or intraparenchymal injection of an isosulfan blue dye, a radiocolloid, or both around the primary malignancy.


METHODS
At the time of selective SLN mapping, 3 to 5 mL of isosulfan blue was injected either intradermally or intraparenchymally around the primary malignancy. From October 1997 to May 2000, 267 patients underwent intraoperative lymphatic mapping with the use of both isosulfan 1% blue dye and radiocolloid injection. Five cases with adverse reactions to isosulfan blue were reviewed.


RESULTS
We report 2 cases of anaphylaxis and 3 cases of "blue hives" after injection with isosulfan blue of 267 patients who had intraoperative lymphatic mapping by the procedure described above. The 2 patients with anaphylaxis experienced cardiovascular collapse, erythema, perioral edema, urticaria, and uvular edema. The blue hives in 3 patients resolved and transformed to blue patches during the course of the procedures.


CONCLUSIONS
The incidence of allergic reactions in our series was 2.0%. As physicians expand the role of SLN mapping, they should consider the use of histamine blockers as prophylaxis and have emergency treatment readily available to treat the life- threatening complication of anaphylactic reaction.
Cimmino
V M
VM
Department of Surgery, University of Michigan Medical School and University Hospital, Ann Arbor, MI 48109-0932, USA.
Brown
A C
AC
Szocik
J F
JF
Pass
H A
HA
Moline
S
S
De
S K
SK
Domino
E F
EF
D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced / Q000503:physiopathology; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012394:Rosaniline Dyes / Q000009:adverse effects*; D021701:Sentinel Lymph Node Biopsy; D014581:Urticaria / Q000139:chemically induced / Q000503:physiopathology
D012394:Rosaniline Dyes; C025484:iso-sulfan blue