Asia Pac Allergy.  2012 Jan;2(1):86-89. 10.5415/apallergy.2012.2.1.86.

Anaphylaxis to Patent Blue V: a case series

• Manson AL
• Juneja R
• Self R
• Farquhar-Smith P
• MacNeill F
• Seneviratne SL

• KMID: 2397415
• DOI: http://doi.org/10.5415/apallergy.2012.2.1.86

Abstract

Blue dyes such as Patent Blue V (PBV) have been used in medical procedures for decades, and in the United Kingdom they are routinely utilised in sentinel lymph node biopsy (SLNB) for staging the axilla in early breast cancer. However, it has long been recognised that such dyes are associated with anaphylaxis. It has recently been estimated in a prospective study that allergy to PBV occurs with a frequency of 0.9%. Since repeated SLNB (and therefore further exposure to PBV) is increasingly being advocated for the small proportion of patients who develop a local (in-breast) recurrence, and because anaphylaxis can be life-threatening, it is important that those individuals that are allergic to PBV are recognised on their first medical exposure. The measurement of serum mast-cell tryptase (MCT) and skin prick test (SPT) are used in the investigation of suspected anaphylaxis because positive results are supportive of type-1 mediated hypersensitivity. Here we report the clinical features, MCT results and SPT results that pertain to a series of four patients referred to our drug allergy clinic with suspected anaphylaxis following SLNB. We recommend that all patients that show clinical evidence of allergy following exposure to PBV are referred to a specialist drug allergy service for further evaluation to investigate the cause.

Keyword

Anaphylaxis; Tryptase; Skin prick test; Blue dye; Lymph-node biopsy

MeSH Terms

Anaphylaxis*
Axilla
Breast Neoplasms
Coloring Agents
Drug Hypersensitivity
Great Britain
Humans
Hypersensitivity
Prospective Studies
Recurrence
Sentinel Lymph Node Biopsy
Skin
Specialization
Tryptases
Coloring Agents
Tryptases

Reference

1. National Institute for Health and Clinical Excellence. Early and locally advanced breast cancer: diagnosis and treatment. Available from: http://www.nice.org.uk/nicemedia/pdf/CG80NICEGuideline.pdf.

2. Kopp WL. Anaphylaxis from alphazurine 2G during lymphography. JAMA. 1966. 198:668–669.

3. Sinclair DJ, Perera FA. Allergic reactions: following patent blue dye injection. Can Med Assoc J. 1969. 101:100–101.

4. Barthelmes L, Goyal A, Newcombe RG, McNeill F, Mansel RE. Adverse reactions to patent blue V dye - The NEW START and ALMANAC experience. Eur J Surg Oncol. 2010. 36:399–403.

5. Kalimo K, Jansén CT, Kormano M. Sensitivity to Patent Blue dye during skin-prick testing and lymphography. A retrospective and prospective study. Radiology. 1981. 141:365–367.

6. Beenen E, de Roy van Zuidewijn DB. Patients blue on patent blue: an adverse reaction during four sentinel node procedures. Surg Oncol. 2005. 14:151–154.

7. Mansouri R, Chicken DW, Keshtgar MR. Allergic reactions to patent blue dye. Surg Oncol. 2006. 15:58.

8. Keller B, Yawalkar N, Pichler C, Braathen LR, Hunger RE. Hypersensitivity reaction against patent blue during sentinel lymph node removal in three melanoma patients. Am J Surg. 2007. 193:122–124.

9. Forschner K, Kleine-Tebbe A, Zuberbier T, Worm M. Type I sensitization towards patent blue as a cause of anaphylaxis. Allergy. 2003. 58:457–458.

10. Wöhrl S, Focke M, Hinterhuber G, Stingl G, Binder M. Near-fatal anaphylaxis to patent blue V. Br J Dermatol. 2004. 150:1037–1038.

11. Johansson SG, Nopp A, Oman H, Stahl-Skov P, Hunting AS, Guttormsen AB. Anaphylaxis to Patent Blue V. II. A unique IgE-mediated reaction. Allergy. 2010. 65:124–129.

12. Woltsche-Kahr I, Komericki P, Kränke B, Brabek E, Horn M, Schuller-Petrovic S, Richtig E, Aberer W. Anaphylactic shock following peritumoral injection of patent blue in sentinel lymph node biopsy procedure. Eur J Surg Oncol. 2000. 26:313–314.

13. Mertes PM, Malinovsky JM, Mouton-Faivre C, Bonnet-Boyer MC, Benhaijoub A, Lavaud F, Valfrey J, O'Brien J, Pirat P, Lalourcey L, Demoly P. Anaphylaxis to dyes during the perioperative period: reports of 14 clinical cases. J Allergy Clin Immunol. 2008. 122:348–352.

14. Harper NJ, Dixon T, Dugué P, Edgar DM, Fay A, Gooi HC, Herriot R, Hopkins P, Hunter JM, Mirakian R, Pumphrey RS, Seneviratne SL, Walls AF, Williams P, Wildsmith JA, Wood P, Nasser AS, Powell RK, Mirakhur R, Soar J. Suspected anaphylactic reactions associated with anaesthesia. Anaesthesia. 2009. 64:199–211.

15. Haque RA, Wagner A, Whisken JA, Nasser SM, Ewan PW. Anaphylaxis to patent blue V: a case series and proposed diagnostic protocol. Allergy. 2010. 65:396–400.

16. Hunting AS, Nopp A, Johansson SG, Andersen F, Wilhelmsen V, Guttormsen AB. Anaphylaxis to Patent Blue V. I. Clinical aspects. Allergy. 2010. 65:117–123.

17. Barthelmes L, Goyal A, Sudheer P, Mansel RE. Investigation of anaphylactic reaction after patent blue V dye injection. Breast. 2010. 19:516–520.