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.

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

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