Biphasic anaphylactic reaction to blue dye during sentinel lymph node biopsy.
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.
Liang
Margaret I
MI
Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA. Margaret.Liang@osumc.edu
Carson
William E
WE
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
D000322:Adrenergic Agonists; D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D004837:Epinephrine