Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis: results of a surgical prospective clinical practice protocol.
BACKGROUND
Severe anaphylactoid reactions to isosulfan blue dye requiring resuscitation are reported to occur in 1.1% of patients with breast carcinoma undergoing sentinel lymphadenectomy. In December 2001, the authors began administering a prophylactic regimen before dye injection to determine whether prophylaxis reduced the incidence of life-threatening reactions.


METHODS
All patients were mapped with technetium-99m-labeled sulfur colloid. Those also receiving isosulfan blue dye were administered a glucocorticoid, diphenhydramine, and famotidine intravenously just before or at induction of anesthesia. Adverse reactions at the time of surgery were analyzed.


RESULTS
Between December 2001 and July 2003, 1013 consecutive patients underwent sentinel lymphadenectomy for breast carcinoma. Six hundred sixty-seven patients (65.8%) received prophylaxis and isosulfan blue dye, 33 (3.3%) received prophylaxis but no dye, 12 (1.2%) received dye but no prophylaxis, and 301 (29.7%) received no prophylaxis or dye. Blue urticaria and facial edema were observed in 3 (0.5%) of 667 patients receiving prophylaxis and dye and in 1 (8.3%) of 12 patients receiving dye but no prophylaxis. There were no episodes of hypotension, and no patients required vasopressors, ventilatory support, or intensive care observation. Adverse reactions to agents other than blue dye were observed in 2 (0.3%) of 667 patients receiving prophylaxis and dye and in 3 (1.0%) of 301 receiving no prophylaxis and no dye (P = 0.1773).


CONCLUSIONS
Preoperative prophylaxis was found to reduce the severity, but not the overall incidence, of adverse reactions to isosulfan blue dye. No life-threatening reactions were noted in patients treated with preoperative prophylaxis. Based on these results, the authors now routinely recommend administration of prophylaxis to patients receiving isosulfan blue for lymphatic mapping and sentinel lymph node biopsy.
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Chandrajit P
CP
Raut
Kelly K
KK
Hunt
Jeri S
JS
Akins
M Denise
MD
Daley
Merrick I
MI
Ross
S Eva
SE
Singletary
Gailen D
GD
Marshall
Funda
F
Meric-Bernstam
Gildy
G
Babiera
Barry W
BW
Feig
Frederick C
FC
Ames
Henry M
HM
Kuerer
D000368:Aged; D000707:Anaphylaxis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D001943:Breast Neoplasms / Q000175:diagnosis*; D002985:Clinical Protocols; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012394:Rosaniline Dyes / Q000009:adverse effects*; D021701:Sentinel Lymph Node Biopsy
D005938:Glucocorticoids; D006634:Histamine H1 Antagonists; D012394:Rosaniline Dyes; C025484:iso-sulfan blue