Anaphylaxis to dyes during the perioperative period: reports of 14 clinical cases.
BACKGROUND
Vital dyes are widely used for lymphatic mapping and sentinel lymph node biopsy in patients with malignant tumors, and reports of anaphylactic reactions are becoming more frequent.


OBJECTIVE
Our aims were to describe specific clinical features of hypersensitivity reactions to Patent Blue (Guerbet, Roissy, France), results of the allergy workup, and their consequences for patient management.


METHODS
We report a series of 14 clinical cases of dye-induced anaphylaxis recorded between 2004 and 2006 in 4 member centers of a network of French allergoanesthesia outpatient clinics.


RESULTS
Reactions appeared to be relatively severe (6/14 grade III reactions). An average 30 +/- 6-minute delay was observed between dye injection and symptom onset. In 9 (65%) patients reactions were sustained for several hours, requiring prolonged continuous epinephrine infusion and transfer to an intensive care unit. Prick test results were positive in 8 patients. In 5 patients prick test results were negative, whereas intradermal test results were positive.


CONCLUSIONS
Anesthesiologists and allergologists must be aware of this specific risk and of the clinical characteristics of these reactions, which are usually delayed and long lasting.
Service d'Anesthésie-Réanimation, Hôpital Central, Centre Hospitalier Universitaire de Nancy, Nancy, France. pm.mertes@chu-nancy.fr
Paul Michel
PM
Mertes
Jean Marc
JM
Malinovsky
Claudie
C
Mouton-Faivre
Marie Caroline
MC
Bonnet-Boyer
Abdelhaouad
A
Benhaijoub
François
F
Lavaud
Jocelyne
J
Valfrey
James
J
O'Brien
Philippe
P
Pirat
Laurent
L
Lalourcey
Pascal
P
Demoly
D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced* / Q000276:immunology; D004396:Coloring Agents / Q000009:adverse effects*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012394:Rosaniline Dyes / Q000009:adverse effects* / Q000737:chemistry / Q000276:immunology
D004396:Coloring Agents; D012394:Rosaniline Dyes; C008769:sulfan blue