NEJM Images: Blue hives due to isosulfan blue dye

The NEJM published a case of "Blue Hives" due to a type I, IgE-mediated hypersensitivity to isosulfan blue dye used intraoperatively to define the associated lymphatic drainage.

The patient was treated with phenylephrine IV (50 mg) and was discharged home 4 hours later.

This is a mnemonic for Gell and Goombs classification of hypersensitivity reactions: ACID

Anaphylaxis, angioedema, asthma, type I
Cytotoxic, antibody-mediated, type II, e.g AIHA, ITP, Graves'
Immune complex disease (CIC), type III, e.g. GN, serum sickness
Delayed, cell-mediated, type IV, e.g. contact dermatitis


Figure 1. Skin reactions to drugs.


Figure 2. Mind map diagram of adverse reactions to drugs. See more Allergy and Immunology mind maps here.

References:
Blue Hives. NEJM Images in Clinical Medicine, 02/2008.
Adverse Reactions to Drugs: A Short Review. Allergy Cases.