Original CommunicationsAllergic reactions to isosulfan blue during sentinel node biopsy—a common event*
Section snippets
Patient 1
A 22-year-old woman with a melanoma of the right shoulder had an uncomplicated general anesthesia induced with use of a laryngeal mask airway, followed by intradermal injection of 3 mL of 1% Lymphazurin blue dye. Ten minutes later, the patient became hypotensive (blood pressure = 60/40 mm Hg) associated with diffuse erythema and facial and uvular edema. Decreasing the depth of anesthesia failed to improve her blood pressure, until large volumes of crystalloid and colloid had been infused. The
Patient 2
A 72-year-old man, with no known allergies and a melanoma on his back, had an uncomplicated endotracheal intubation, followed by injection of 3 mL of 1% Lymphazurin blue dye. Eight minutes later, he became hypotensive and mottled with facial and uvular edema. Decreasing the depth of anesthesia failed to improve his blood pressure. Because of a positive cardiac history, blood was drawn for determination of appropriate enzyme levels, and a transesophageal echocardiogram was performed. The
Patient 3
A 50-year-old woman with a diagnosis of invasive lobular carcinoma underwent a successful endotracheal intubation, followed by injection of 3 mL of 1% Lymphazurin blue dye intraparenchymally around the old biopsy site. About 40 minutes later, hypotension and bradycardia developed. Hypotension and bradycardia did not respond to ephedrine and epinephrine initially but were reversed with the addition of diphenhydramine, famotidine, and methylprednisolone. She had been given cefazolin but had no
Patients 4 and 5
Two 47-year-old women with breast carcinomas underwent breast conserving lumpectomy and sentinel node mapping and biopsy. Both patients were injected with 5 mL of 1% Lymphazurin blue dye subcutaneously near the previous biopsy site. “Blue hives,” involving the entire upper trunk and upper extremities without a decrease in blood pressure or other manifestations of allergic reaction, developed in both the patients 30 to 40 minutes after injection of the dye. In these patients, blue hives can be
Discussion
The use of Lymphazurin 1% became popular in lymphography through the 1970s, when it was replaced by new techniques. Patent Blue Violet is a triphenylmethane dye virtually identical to Lymphazurin 1%. Lymphazurin 1% (isosulfan blue) is the first dye of its type to be approved by the Food and Drug Administration for lymphangiography. Triphenylmethane dyes are used extensively in textile industries for dying nylon, wool, silk, and cotton.6 They have further use as medicines and biologic stains in
Conclusion
As physicians expand the role of sentinel lymph node mapping in the management of high-risk malignancies, they should be reminded of the potential for triphenylmethane dyes to produce allergic reactions. Emergency treatment must be readily available during procedures involving these dyes (eg, Lymphazurin 1%), and health care personnel working with these compounds should be aware that a negative history of drug allergy before exposure does not preclude the possibility of a life-threatening
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2018, Clinical Breast CancerCitation Excerpt :Dual tracer techniques might fail in up to 25% of patients who undergo NAC and do not discriminate the biopsied node from another LN.10,11 Blue dye has been associated with allergic reactions and rarely anaphylaxis.22-24 Furthermore, studies discussing SLNB after NAC report success in finding a sentinel node, not necessarily the PBN.
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2018, The Breast: Comprehensive Management of Benign and Malignant Diseases
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Reprint requests: Vincent M. Cimmino, MD, 1500 E Medical Center Dr, 3214 Cancer Center, Ann Arbor, MI 48109-0932.