Anaphylactic reaction to patent blue V after sentinel lymph node biopsy.
BACKGROUND
We report a documented grade III IgE-mediated hypersensitivity reaction associated with the use of 2.5% patent blue V dye for sentinel lymph node biopsy during breast cancer surgery.


METHODS
Immediately after the reaction, when hemodynamic stability was obtained, plasma histamine was measured whereas serum tryptase was not. Six weeks later, with the patient's consent, cutaneous tests to patent blue V dye, methylene blue dye, latex and all drugs used during surgery were performed according to standardized procedures.


CONCLUSIONS
Clinical symptoms, biological assessment results and cutaneous tests positivity confirmed the onset of an anaphylactic reaction due to patent blue V. Of interest, the positivity of the cutaneous tests observed with patent blue V was not found with methylene blue which might be proposed for further investigations in our patient. This case report confirms the need for systematic allergological investigation of all drugs and substances administered during the peri-operative period in case of an immediate hypersensitivity reaction occurring during anesthesia.
Dewachter
P
P
Service d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire (CHU), Nancy, France. pascale.dewachter@wanadoo.fr
Mouton-Faivre
C
C
Benhaijoub
A
A
Abel-Decollogne
F
F
Mertes
P M
PM
D000707:Anaphylaxis / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D001943:Breast Neoplasms / Q000601:surgery*; D004396:Coloring Agents / Q000009:adverse effects*; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D006632:Histamine / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008751:Methylene Blue / Q000008:administration & dosage; D008875:Middle Aged; D012394:Rosaniline Dyes / Q000009:adverse effects*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012882:Skin Tests / Q000379:methods; D013610:Tachycardia / Q000139:chemically induced / Q000188:drug therapy; D014581:Urticaria / Q000139:chemically induced / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004396:Coloring Agents; D004791:Enzyme Inhibitors; D012394:Rosaniline Dyes; D014662:Vasoconstrictor Agents; D006632:Histamine; C008769:sulfan blue; D004809:Ephedrine; D008751:Methylene Blue; D006854:Hydrocortisone