Anaphylaxis to Patent Blue V dye used used for staging procedures in breast cancer

The dye Patent Blue V (PBV) is increasingly used for staging procedures in breast cancer but is reported to cause adverse reactions.

9 patients with hypersensitivity reactions to PBV who were identified through the Norwegian network for reporting allergic reactions during anesthesia.

There was an incidences of 0.5% for all kinds of PBV reactions and 0.4% for anaphylaxis.

Typical clinical features included:

- cardiovascular and/or cutaneous symptoms
- a delay in symptoms, compared to the time of dye injection
- poor response to ephedrine and intravenous fluid
- need for adrenaline administration, sometimes prolonged, for circulatory stabilization

During anaphylactic reactions, serum tryptase was increased in 6 patients and normal in one.

Skin prick tests to PBV were positive in all 8 patients tested.

The clinical features and the results of follow-up studies strongly suggest that these reactions are IgE mediated.

References:
Anaphylaxis to Patent Blue V. Clinical aspects. A. S. Hunting, A. Nopp, S. G. O. Johansson, F. Andersen, V. Wilhelmsen, A. B. Guttormsen. Allergy. 2009.
Image source: Blue. Wikipedia, public domain.