title: Biphasic anaphylactic reaction to blue dye during sentinel lymph node biopsy.
abstract: BACKGROUND
  Lymphazurin 1% blue dye can cause a severe anaphylactic reaction in approximately 1-3% of patients.
  
  
  METHODS
  We describe a case of intraoperative anaphylaxis resulting from Lymphazurin 1% blue dye. A 48-year old woman undergoing a mastectomy with sentinel lymph node biopsy experienced a biphasic anaphylactic reaction with two episodes of hypotension at 15 minutes and 2 hours, respectively, after injection of the blue dye. The late phase was initially refractory to epinephrine.
  
  
  CONCLUSIONS
  Early recognition, aggressive hemodynamic management, and prolonged monitoring are indicated in these patients to watch for a potential second phase anaphylactic reaction.
authors.affiliation: Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA. Margaret.Liang@osumc.edu
authors.forename: Margaret I
authors.initials: MI
authors.lastname: Liang
authors.forename: William E
authors.initials: WE
authors.lastname: Carson
mesh_terms: D000322:Adrenergic Agonists / Q000627:therapeutic use; D000707:Anaphylaxis / Q000139:chemically induced* / Q000188:drug therapy; D001943:Breast Neoplasms / Q000601:surgery*; D004396:Coloring Agents / Q000009:adverse effects*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008408:Mastectomy; D008875:Middle Aged; D012394:Rosaniline Dyes / Q000009:adverse effects*; D021701:Sentinel Lymph Node Biopsy
chemical_list: D000322:Adrenergic Agonists; D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D004837:Epinephrine