Anaphylaxis to patent blue V: a case series and proposed diagnostic protocol

Abstract

Patent blue V is widely used in the identification of sentinel lymph nodes in patients with breast cancer and other malignancies. Individual case reports of allergy to patent blue V have been described in the medical literature since the 1960s. However, there is little data on clinical features and little experience of which allergy tests are appropriate or useful. We gathered all cases of patent blue V allergy that had been seen and diagnosed in the Department of Allergy, Addenbrooke's Hospital over a 3-year period. We collected clinical details of each case including skin test results. For comparison we recruited 12 healthy control subjects who then underwent skin testing to patent blue V. Six cases of patent blue V allergy were identified, all occurring during sentinel lymph node identification for breast carcinoma. All 6 had positive skin prick tests to neat patent blue V (25 mg/ml). Skin prick testing with a 1 : 10 dilution (2.5 mg/ml) produced positive results in 3 of 4 patients tested, and intradermal testing at a 1 : 100 dilution was (0.25 mg/ml) was positive in all patients tested. Of 12 control subjects, 11 had negative skin prick tests to both neat and 1 : 10 patent blue V with one subject showing a positive reaction to the higher concentration only. On the basis of our experience of patent blue V allergy, we propose a diagnostic protocol that can be safely and reliably utilised in centres equipped for allergy testing.

Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic

“…All 12 reactions to patent blue in our series were classed as severe reactions (grade 3), with hypotension being a prominent feature in all cases. This emphasises the importance of the warning from the European Medicines Agency [33] that healthcare professionals need to be made aware of the risk of anaphylactic reactions whenever these agents are used [34].…”

Effect of Patent Blue V® dye on sample interference indices on the Abbott Architect

“…2 Its use carries the potentially fatal side-effect of anaphylatic reaction. 3,4 The dye has also been shown to cause interference in pulse oximetry and co-oximetry. 5 We noticed that administration of Patent Blue V w dye for a surgical procedure caused a patient's serum sample to take on a green appearance, which was most apparent in the sample taken immediately postsurgery.…”

Severe decrease in SpO2 and methemoglobinemia following subareolar isosulfan blue administration and clinical relevance

“…Unfortunately, as a disadvantage of regional staining, methemoglobinemia is one of the most frequent complications seen following isosulfan blue injection, in addition to allergic reactions ranging from simple rashes to anaphylactic reactions (3)(4)(5). The amount of methemoglobin (MetHb), which is an abnormal form of the hemoglobin molecule, is normally less than 1%.…”