title: [Acute blue urticaria following subcutaneous injection of patent blue dye].
abstract: BACKGROUND
  Patent blue (PB) is a lymphatic vessel dye commonly used in France for sentinel lymph node detection in breast cancer, and less frequently in melanoma, and which may induce hypersensitivity reactions. We report a case of acute blue urticaria occurring within minutes of PB injection.
  
  
  METHODS
  Ten minutes after PB injection for sentinel lymph node detection during breast cancer surgery, a 49-year-old woman developed generalised acute blue urticaria and eyelid angioedema without bronchospasm or haemodynamic disturbance, but requiring discontinuation of surgery. Skin testing using PB and the anaesthetics given were run 6 weeks after the episode and confirmed PB allergy. PB was formally contra-indicated.
  
  
  CONCLUSIONS
  Immediate hypersensitivity reactions to PB have been reported for between 0.24 and 2.2% of procedures. Such reactions are on occasion severe, chiefly involving anaphylactic shock. Two mechanisms are probably associated: non-specific histamine release and/or an IgE-mediated mechanism. Skin tests are helpful in confirming the diagnosis of PB allergy.
  
  
  CONCLUSIONS
  Blue acute urticaria is one of the clinical manifestations of immediate hypersensitivity reactions to patent blue dye. Skin tests must be performed 6 weeks after the reaction in order to confirm the diagnosis and formally contra-indicate this substance.
authors.affiliation: Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: auroredeblignieres@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Hamelin
authors.affiliation: Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Vial-Dupuy
authors.affiliation: Centre de pharmacovigilance, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Lebrun-Vignes
authors.affiliation: Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 6, 4, place Jussieu, 75005 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Francès
authors.affiliation: Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 6, 4, place Jussieu, 75005 Paris, France; Unité mixte de recherche de santé (UMRS) CR7, centre d'immunologie et des maladies infectieuses-Paris (Cimi-Paris), 75013 Paris, France; Institut national de santé et de recherche médicale (Inserm) U1135, Cimi-Paris, 75013 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Soria
authors.affiliation: Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 6, 4, place Jussieu, 75005 Paris, France; Unité fonctionnelle de dermatologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Barete
mesh_terms: D000799:Angioedema / Q000139:chemically induced; D001943:Breast Neoplasms / Q000473:pathology; D004396:Coloring Agents / Q000009:adverse effects*; D005143:Eyelids / Q000473:pathology; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D008751:Methylene Blue / Q000009:adverse effects*; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D013997:Time Factors; D014581:Urticaria / Q000139:chemically induced*
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue
keywords: Bleu patenté; Blue urticaria; Breast cancer; Cancer du sein; Ganglion sentinelle; Hypersensibilité; Hypersensitivity; Patent blue dye; Sentinel lymph node; Urticaire bleue