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.

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.

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