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Misir Šitum S, Korečić Zrinjščak I, Pečvarac M, Šoštar A, Žaja A, Tot T. Case report: Atypical anaphylactic reaction to Patent Blue V dye during breast cancer surgery. Front Oncol 2022; 12:979393. [PMID: 36185281 PMCID: PMC9523237 DOI: 10.3389/fonc.2022.979393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
The most common causes of perioperative hypersensitive reactions are neuromuscular blocking drugs, latex, and antibiotics, although there are other more emerging causative agents. Allergic reactions to Patent Blue V (PBV) dye have been reported. Most of them are mild and presented with blue coloration of cutaneous plaque. The PBV dye is widely used in the identification of sentinel lymph nodes in patients with breast cancer and other malignancies. Here, we present a case of 33-year-old patient with carcinoma of the breast proposed for sentinel lymph node and skin-sparing mastectomy with severe, life-threatening anaphylaxis which occurred immediately after PBV dye was injected, with cardiopulmonal resuscitation and prolonged refractory hypotension. The patient was without previous exposure to PBV and signs of skin rash, erythema, or bronchospasm, making the diagnosis and management of such cases challenging. Skin tests were performed on all drugs used in premedication and induction of anesthesia and PBV showed positive at IDT of 1:10. Physicians must always think of possible adverse reaction to PBV and for the potential risk of anaphylactic reaction immediately after the dye is injected, during anesthesia and other procedures.
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Dumitru D, Ghanakumar S, Provenzano E, Benson JR. A Prospective Study Evaluating the Accuracy of Indocyanine Green (ICG) Fluorescence Compared with Radioisotope for Sentinel Lymph Node (SLN) Detection in Early Breast Cancer. Ann Surg Oncol 2022; 29:3014-3020. [DOI: 10.1245/s10434-021-11255-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
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Chen SY, Tran KD, Wehrer S, Potts LB, Bauer AJ, Straiko MD, Terry MA. Patent Blue V as an Alternative Stain for DMEK Grafts: Safety, Stain Retention, and Feasibility. Cornea 2019; 38:1322-1327. [PMID: 31205156 DOI: 10.1097/ico.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether Patent Blue V (PB) can be used as an alternative dye for staining Descemet membrane endothelial keratoplasty (DMEK) grafts. METHODS DMEK grafts from donor corneas were stained with 2.5% PB for 4 minutes (n = 2), 2.5% PB for 10 minutes (n = 2), or 0.06% trypan blue (TB) for 4 minutes (n = 1). The stain intensity of the grafts was compared initially and at different time points over a 15-minute period of balanced salt solution wash using a grading scale based on a serial dilution series of PB. Three additional grafts were stained with 2.5% PB for 10 minutes and used in mock surgeries to assess stain retention after injection and manipulation in a donor eye model for 25 minutes. To assess the safety of PB, DMEK grafts were prepared from 10 pairs of corneas where one cornea was stained with 0.06% TB for 4 minutes and the mate cornea was stained with 2.5% PB for 10 minutes. The grafts were preloaded and stored for 5 days in Optisol-GS at 2°C to 8°C, and endothelial cell loss was quantified using Calcein-AM staining and FIJI segmentation by 2 masked readers. RESULTS PB stain intensities were lighter than TB-stained grafts. Grafts stained with 2.5% PB for 10 minutes retained sufficient color for the 25-minute duration of mock surgery. The average endothelial cell loss for PB versus TB grafts was 21.6% ± 5.3% versus 20.2% ± 5.4% (P = 0.202) as determined by reader 1 and 23.6% ± 4.8% versus 21.2% ± 5.8% (P = 0.092) as determined by reader 2. CONCLUSIONS PB is a viable alternative dye in DMEK grafts for applications where TB may not be available or approved for use.
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Affiliation(s)
- Shin-Yi Chen
- Cornea Service, Devers Eye Institute, Portland, OR.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | | | - Luke B Potts
- Cornea Service, Devers Eye Institute, Portland, OR
| | | | | | - Mark A Terry
- Cornea Service, Devers Eye Institute, Portland, OR
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Anaesthetic management of patients with pre-existing allergic conditions: a narrative review. Br J Anaesth 2019; 123:e65-e81. [PMID: 30916009 DOI: 10.1016/j.bja.2019.01.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
This narrative review seeks to distinguish the clinical patterns of pre-existing allergic conditions from other confounding non-allergic clinical entities, and to identify the potential related risks and facilitate their perioperative management. Follow-up investigation should be performed after a perioperative immediate hypersensitivity to establish a diagnosis and provide advice for subsequent anaesthetics, the main risk factor for perioperative immunoglobulin E (IgE)-mediated anaphylaxis being a previous uninvestigated perioperative immediate hypersensitivity reaction. The concept of cross-reactivity between drugs used in the perioperative setting and food is often quoted, but usually not supported by evidence. There is no reason to avoid propofol in egg, soy, or peanut allergy. The allergenic determinants have been characterised for fish, shellfish, and povidone iodine, but remain unknown for iodinated contrast agents. Iodinated drugs may be used in seafood allergy. Evidence supporting the risk for protamine allergy in fish allergy and in neutral protamine Hagedorn insulin use is lacking. Conversely, cross-reactivity to gelatin-based colloid may occur in α-gal syndrome. Atopy and allergic asthma along with other non-allergic conditions, such as NSAID-exacerbated respiratory disease, chronic urticaria, mastocytosis, and hereditary or acquired angioedema, are not risk factors for IgE-mediated drug allergy, but there is a perioperative risk associated with the potential for exacerbation of the various conditions.
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Leung M, McCusker C, Ben-Shoshan M. Anaphylaxis to patent blue dye in a 17-year-old boy. BMJ Case Rep 2019; 12:12/1/e226191. [PMID: 30674488 DOI: 10.1136/bcr-2018-226191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patent blue V dye (PBV) is frequently used as a perioperative drug for lymphangiography, as well as a food additive. Hypersensitivity to PBV is poorly documented in adults and had not been previously described in children. The diagnosis of PBV allergy depends on corroboration of history consistent with an IgE-mediated reaction and confirmatory skin tests. We present in this paper a paediatric case of PBV anaphylaxis and of biphasic reaction that exemplifies the challenges involved in diagnosing and managing this rare but potentially life-threatening allergic reaction.
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Affiliation(s)
- Mélanie Leung
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Christine McCusker
- Division of Pediatric Allergy Immunology and Dermatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy Immunology and Dermatology, Department of Paediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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Kumar S, Dhillon R, Shah S, White DC, Rozen WM. Patent Blue dye allergy and the deep inferior epigastric perforator free flap: a unique interaction. Clin Case Rep 2018; 6:581-584. [PMID: 29636918 PMCID: PMC5889264 DOI: 10.1002/ccr3.1412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/25/2017] [Accepted: 01/05/2018] [Indexed: 11/12/2022] Open
Abstract
Patent Blue dye for sentinel lymph node biopsy is associated with systemic allergic response and generalized blue hue. We report a unique case of successful free flap transfer in this setting. Despite inotropic support and abnormal blue hue, allergic response does not preclude safe flap transfer and monitoring.
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Affiliation(s)
- Shanesh Kumar
- Department of Surgery School of Clinical Science at Monash Health Monash Medical Centre Monash University Block E/Level 5, 246 Clayton Road Clayton Victoria 3168 Australia.,Department of Plastic and Reconstructive Surgery Eastern Health Davey Drive Ringwood East Victoria 3135 Australia
| | - Raminder Dhillon
- Department of Surgery School of Clinical Science at Monash Health Monash Medical Centre Monash University Block E/Level 5, 246 Clayton Road Clayton Victoria 3168 Australia.,Department of Plastic and Reconstructive Surgery Eastern Health Davey Drive Ringwood East Victoria 3135 Australia
| | - Snehal Shah
- Department of Surgery School of Clinical Science at Monash Health Monash Medical Centre Monash University Block E/Level 5, 246 Clayton Road Clayton Victoria 3168 Australia.,Department of Plastic and Reconstructive Surgery Eastern Health Davey Drive Ringwood East Victoria 3135 Australia
| | - Dean C White
- Department of Surgery School of Clinical Science at Monash Health Monash Medical Centre Monash University Block E/Level 5, 246 Clayton Road Clayton Victoria 3168 Australia.,Department of Plastic and Reconstructive Surgery Eastern Health Davey Drive Ringwood East Victoria 3135 Australia
| | - Warren Matthew Rozen
- Department of Surgery School of Clinical Science at Monash Health Monash Medical Centre Monash University Block E/Level 5, 246 Clayton Road Clayton Victoria 3168 Australia.,Department of Plastic and Reconstructive Surgery Eastern Health Davey Drive Ringwood East Victoria 3135 Australia
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El Hage Chehade H, Headon H, Wazir U, Abtar H, Kasem A, Mokbel K. Is sentinel lymph node biopsy indicated in patients with a diagnosis of ductal carcinoma in situ? A systematic literature review and meta-analysis. Am J Surg 2016; 213:171-180. [PMID: 27773373 DOI: 10.1016/j.amjsurg.2016.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/19/2016] [Accepted: 04/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent discussion has suggested that some cases of ductal carcinoma in situ (DCIS) with high risk of invasive disease may require sentinel lymph node biopsy (SLNB). METHODS Systematic literature review identified 48 studies (9,803 DCIS patients who underwent SLNB). Separate analyses for patients diagnosed preoperatively by core sampling and patients diagnosed postoperatively by specimen pathology were conducted to determine the percentage of patients with axillary nodal involvement. Patient factors were analyzed for associations with risk of nodal involvement. RESULTS The mean percentage of positive SLNBs was higher in the preoperative group (5.95% vs 3.02%; P = .0201). Meta-regression analysis showed a direct association with tumor size (P = .0333) and grade (P = .00839) but not median age nor tumor upstage rate. CONCLUSIONS The SLNB should be routinely considered in patients with large (>2 cm) high-grade DCIS after a careful multidisciplinary discussion. In the context of breast conserving surgery, the SLNB is not routinely indicated for low- and intermediate-grade DCIS, high-grade DCIS smaller than 2 cm, or pure DCIS diagnosed by definitive surgical excision.
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Affiliation(s)
- Hiba El Hage Chehade
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK.
| | - Hannah Headon
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK
| | - Umar Wazir
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK
| | - Houssam Abtar
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK
| | - Abdul Kasem
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK
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Greenberger PA. Intraoperative and procedure-related anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:106-7. [PMID: 25577627 DOI: 10.1016/j.jaip.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Paul A Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Elmadahm AA, Gill PG, Bochner M, Gebski VJ, Zannino D, Wetzig N, Campbell I, Stockler M, Ung O, Simes J, Uren R. Identification of the sentinel lymph node in the SNAC-1 trial. ANZ J Surg 2014; 85:58-63. [PMID: 25626066 DOI: 10.1111/ans.12527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND A combination of scintigraphy and a lymphotropic dye (patent blue dye (BD)) is the recommended technique to detect the sentinel lymph node (SLN) in early breast cancer. This study determined the effect of clinical factors on SLN identification in the sentinel node biopsy versus axillary clearance (SNAC) trial. METHODS A total of 1088 women were registered. Lymphatic mapping was performed using preoperative lymphoscintigraphy (LSG) and gamma probe (GP) combined with peritumoural injection of patent BD (971 patients) or BD alone (106 patients). RESULTS SLNs were identified in 1024 women (94%), localized with LSG in 779 (81.4%), and were identified by GP in 879 (91.8%). The BD identified SLNs in 890 of 1073 (82%) women. Three patients had allergic reactions. BD detected the SLNs in 141 of 178 women with negative LSG mapping and in 44 of 79 women with no hot SLNs detected intraoperatively. Age, body mass index (BMI) and tumour presentation (screen detected versus symptomatic) were significantly related to the identification of the SLN. For BD, the primary tumour location was significantly related to identification rate. The detection of blue SLN was significantly lower in women with inner quadrant tumours. CONCLUSION The combined technique resulted in a high identification rate. BD contributed to the identification of the SLNs in patients where LSG and GP failed to identify the sentinel node. Special attention to these techniques is needed in particular groups of patients such as those with high BMI, screen-detected primary tumours and tumour located in the inner quadrants.
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Affiliation(s)
- Amira A Elmadahm
- Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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