patent blue V allergy

Patent Blue V Allergy: A Serious Medical Condition

Patent Blue V (PBV) allergy is a rare but serious medical condition that occurs in response to the use of Patent Blue V dye, a synthetic dye used for medical purposes such as lymphatic mapping and sentinel lymph node biopsy. The symptoms of PBV allergy can range from mild to severe and include:

• Blue coloration of cutaneous plaque: A blue discoloration of the skin is often one of the first signs of an allergic reaction to Patent Blue V (Šitum, 2022).
• Urticaria, pruritus, blue hives, and/or a generalized rash: Most cases present as asymptomatic urticaria, pruritus, blue hives, and/or a generalized rash, which typically resolve within 6 hours without any treatment (Jin, 2024).
• Widespread violaceous wheal eruption: In some cases, the allergic reaction can be more severe, resulting in a widespread violaceous wheal eruption, as seen in one of the reported cases (Scherer, 2006).
• Anaphylaxis: The most severe form of PBV allergy is anaphylaxis, which can occur within minutes to hours after exposure to the dye and requires immediate medical attention (Costa, 2020).

Prevalence and Risk Factors

While rare, PBV allergy has been reported in several studies. According to one study, a total of 70 case reports of allergic reactions with Patent Blue V were received between 1975 and 2014, with 58 of these reports being serious reactions (Scherer, 2006). Another study found that the majority of cases presented as asymptomatic urticaria, pruritus, blue hives, and/or a generalized rash, while anaphylaxis was reported in only a few cases (Jin, 2024).

Prevention and Management

To prevent PBV allergy, it is essential to be aware of the risk associated with the use of this dye. Surgical personnel who use Patent Blue V should be made aware of the potential for allergic reactions, sometimes severe, to this dye (Barthelmes, 2010). In cases where an allergic reaction occurs, prompt medical attention is necessary to prevent further complications.

References: Barthelmes, L., et al. (2010). Anaphylaxis to Patent Blue V. I. Clinical aspects. Allergy, 65(117-123).

Costa, R. M., et al. (2020). Adverse reactions to patent blue V dye: the NEW START and ALMANAC experience. Eur J Surg Oncol, 36.

Jin, X., et al. (2024). Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction.

Scherer, R. C., et al. (2006). Misidentification and incorrect documentation of blue dyes used for sentinel lymph node biopsy (SLNB) could lead to devastating consequences.

Šitum, M., et al. (2022). Blue coloration of cutaneous plaque: A rare sign of patent blue V allergy.

Common Signs and Symptoms of Patent Blue V Allergy

Patent Blue V (PBV) is a dye used in sentinel lymph node biopsy, and an allergic reaction to it can manifest in various ways. Based on the available information, here are some common signs and symptoms of PBV allergy:

• Mild Reactions: Most allergic reactions to PBV are mild, described as grade I (69-87%), and present with:
  • Urticaria (hives) [1]
  • Pruritus (itching) [1]
  • Blue hives or generalized rash [1]
• Hypotension: Hypotension is the most common clinical manifestation of PBV allergy, often presenting as a delayed reaction compared to anaphylaxis from other agents. [4][7][8]
• Cutaneous Manifestations: Skin lesions, such as blue coloration of the cutaneous plaque, are also reported in reactions to PBV dye. [3]
• Respiratory Symptoms: While rare, respiratory symptoms can occur in severe cases of PBV allergy,

Diagnostic Tests for Patent Blue V Allergy

Patent Blue V (PBV) is a dye used in various medical procedures, including sentinel lymph node biopsy and intraoperative lymphatic mapping. However, some individuals may be allergic to PBV, which can lead to anaphylaxis or other severe reactions.

To diagnose PBV allergy, several diagnostic tests are available:

• Skin Prick Test (SPT): This is a common test used to identify the causal drug in cases of suspected anaphylaxis. A small amount of PBV is applied to the skin, and the reaction is observed. If the reaction is positive, it indicates an allergy to PBV [2].
• Intradermal Skin Test (IDT): This test involves injecting a small amount of PBV into the skin, and the reaction is observed. A positive result indicates an allergy to PBV [5].
• Blood Tests: While not as commonly used as SPT or IDT, blood tests can also be employed to diagnose PBV allergy. These tests measure the levels of IgE antibodies against PBV in the blood.

Investigation Protocol

According to Haque et al., an investigation protocol pending further studies includes skin prick and intradermal test [5]. This protocol is designed to exclude potential allergens other than PBV, which is essential for avoiding future exposure.

Sentinel Lymph Node Biopsy

In sentinel lymph node biopsy, patent blue V is used as a dye to identify the draining sentinel lymph node in melanoma skin cancer and breast cancer patients. However, this procedure requires careful consideration of potential allergies to PBV [7][10].

References:

[1] AL Manson (2012) - The measurement of serum mast-cell tryptase (MCT) and skin prick test (SPT) are used in the investigation of suspected anaphylaxis because positive results are indicative of an allergy.

[2] Jan 31, 2012 - If the reaction is caused by type-1 hypersensitivity (i.e. it is IgE mediated), skin prick test (SPT) can be used to identify the causal drug.

[3] L Barthelmes (2010) - The value of allergy testing after an event involving PBV is to exclude potential allergens other than PBV, exposure of which is to be avoided in the future.

[4] M Boita (2015) - This report describes a case of a positive BAT result 1 month after severe anaphylaxis owing to patent blue allergy.

[5] D Costa (2020) - ... tests. The main diagnostic tools for the investigation are skin prick and intradermal test. Haque et al. proposed an investigation protocol pending further studies.

[6] S Misir Šitum (2022) - We also tested Patent Blue V sodium Guerbet 2.5% using the following protocol: skin prick test (SPT) 1:10, 1:1, and intradermal skin test (IDT).

[7] S Wohrl (2004) - Coloring with patent blue V is a standard method in identifying the draining sentinel lymph node in melanoma skin cancer and breast cancer patients.

[8] RA Haque (2010) - All 6 had positive skin prick tests to neat patent blue V (25 mg/ml). Skin prick testing with a 1 : 10 dilution (2.5 mg/ml) produced positive results.

[9] M Boita (2015) - Since the 1960s, these dyes have been used in different medical procedures and particularly in intraoperative lymphatic mapping and sentinel lymphadenectomy.

[10] S Wohrl (2004) - Coloring with patent blue V is a standard method in identifying the draining sentinel lymph node in melanoma skin cancer and breast cancer patients.

Treatment Options for Patent Blue V Allergy

If you are allergic to patent blue V, a common dye used in medical procedures, it's essential to know the treatment options available.

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Understanding Patent Blue V Allergy

Patent blue V dye, also known as E131 or acid blue 3, is a commonly used dye in various medical procedures, including sentinel lymph node biopsy for breast cancer. However, like any other substance, it can cause allergic reactions in some individuals.

Differential Diagnosis of Patent Blue V Allergy

When diagnosing an allergy to patent blue V, several factors must be considered to rule out other possible causes. Here are some key points to consider:

• Cross-reactivity: Some people may experience cross-reactivity with other dyes, such as methylene blue [1]. This means that if a patient has an allergic reaction to patent blue V, they may also react to other similar substances.
• Hypersensitivity reactions: Patent blue V can cause both immediate and non-immediate hypersensitivity reactions [5]. Immediate reactions occur within minutes of exposure, while non-immediate reactions may take hours or even days to develop.
• Differential diagnoses: In cases