NEW YORK (Reuters Health), Sep 26 - French anesthesiologists warn that the dyes used for sentinel lymph node mapping can cause anaphylactic reactions that may not develop until an hour after exposure, can be life-threatening, and can last for several hours, requiring continuous infusions of epinephrine to control.
Fourteen cases of anaphylactic reactions to Patent Blue dye occurring between 2004 and 2006 at four centers are reported in the September issue of the Journal of Allergy and Clinical Immunology by Dr. Paul Michel Mertes, of Centre Hospitalier Universitaire de Nancy, and colleagues.
Grade III anaphylactic reactions to Patent Blue occurred in six of the 14 cases. There was an average delay of slightly more than 30 minutes between dye injection and symptom onset, with a minimum of 10 minutes and a maximum of 60 minutes between dye injection and symptom onset in the 14 cases.
Symptom duration was several hours in nine cases (65%), "requiring prolonged continuous epinephrine infusion and transfer to an intensive care unit."
Prick tests were positive in eight cases. In five cases with negative prick tests, positive results were obtained with intradermal testing.
"Our results strongly suggest favoring intradermal tests, using up to a 1:100 dilution for the diagnosis of sensitization to blue dyes in patients with a history of a possible immediate hypersensitivity reaction to dyes," the researchers write.
"We also recommend systematic testing with methylene blue in case of hypersensitivity to Patent Blue dye. Indeed, methylene blue has also been shown to be an effective dye for sentinel lymph node localization, with only a limited number of complications reported."
J Allergy Clin Immunol 2008;122:348-352.
Last Updated: 2008-09-26 12:40:03 -0400 (Reuters Health)
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