A Hamelin1, A Vial-Dupuy2, B Lebrun-Vignes3, C Francès4, A Soria5, S Barete6. 1. Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: auroredeblignieres@gmail.com. 2. Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. 3. Centre de pharmacovigilance, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France. 4. Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 6, 4, place Jussieu, 75005 Paris, France. 5. Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 6, 4, place Jussieu, 75005 Paris, France; Unité mixte de recherche de santé (UMRS) CR7, centre d'immunologie et des maladies infectieuses-Paris (Cimi-Paris), 75013 Paris, France; Institut national de santé et de recherche médicale (Inserm) U1135, Cimi-Paris, 75013 Paris, France. 6. Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 6, 4, place Jussieu, 75005 Paris, France; Unité fonctionnelle de dermatologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Abstract
BACKGROUND: Patent blue (PB) is a lymphatic vessel dye commonly used in France for sentinel lymph node detection in breast cancer, and less frequently in melanoma, and which may induce hypersensitivity reactions. We report a case of acute blue urticaria occurring within minutes of PB injection. PATIENTS AND METHODS: Ten minutes after PB injection for sentinel lymph node detection during breast cancer surgery, a 49-year-old woman developed generalised acute blue urticaria and eyelid angioedema without bronchospasm or haemodynamic disturbance, but requiring discontinuation of surgery. Skin testing using PB and the anaesthetics given were run 6 weeks after the episode and confirmed PB allergy. PB was formally contra-indicated. DISCUSSION: Immediate hypersensitivity reactions to PB have been reported for between 0.24 and 2.2% of procedures. Such reactions are on occasion severe, chiefly involving anaphylactic shock. Two mechanisms are probably associated: non-specific histamine release and/or an IgE-mediated mechanism. Skin tests are helpful in confirming the diagnosis of PB allergy. CONCLUSION: Blue acute urticaria is one of the clinical manifestations of immediate hypersensitivity reactions to patent blue dye. Skin tests must be performed 6 weeks after the reaction in order to confirm the diagnosis and formally contra-indicate this substance.
BACKGROUND:Patent blue (PB) is a lymphatic vessel dye commonly used in France for sentinel lymph node detection in breast cancer, and less frequently in melanoma, and which may induce hypersensitivity reactions. We report a case of acute blue urticaria occurring within minutes of PB injection. PATIENTS AND METHODS: Ten minutes after PB injection for sentinel lymph node detection during breast cancer surgery, a 49-year-old woman developed generalised acute blue urticaria and eyelid angioedema without bronchospasm or haemodynamic disturbance, but requiring discontinuation of surgery. Skin testing using PB and the anaesthetics given were run 6 weeks after the episode and confirmed PBallergy. PB was formally contra-indicated. DISCUSSION: Immediate hypersensitivity reactions to PB have been reported for between 0.24 and 2.2% of procedures. Such reactions are on occasion severe, chiefly involving anaphylactic shock. Two mechanisms are probably associated: non-specific histamine release and/or an IgE-mediated mechanism. Skin tests are helpful in confirming the diagnosis of PBallergy. CONCLUSION: Blue acute urticaria is one of the clinical manifestations of immediate hypersensitivity reactions to patent blue dye. Skin tests must be performed 6 weeks after the reaction in order to confirm the diagnosis and formally contra-indicate this substance.
Keywords:
Bleu patenté; Blue urticaria; Breast cancer; Cancer du sein; Ganglion sentinelle; Hypersensibilité; Hypersensitivity; Patent blue dye; Sentinel lymph node; Urticaire bleue
Authors: Stanka Misir Šitum; Iva Korečić Zrinjščak; Maja Pečvarac; Andrea Šoštar; Ana Žaja; Tea Tot Journal: Front Oncol Date: 2022-09-16 Impact factor: 5.738