E. Tsai, J. Tencati, W. Chen
Feb 1, 2004
Citations
0
Influential Citations
4
Citations
Quality indicators
Journal
The Journal of Allergy and Clinical Immunology
Abstract
Abstract Rationale Isosulfan is a triphenylmethane dye commonly used to color textiles, cosmetics, detergents, paints, and medications. Isosulfan blue is also frequently used for lymphangiography in sentinel node biopsy in patients with melanoma and breast cancer. We are reporting two patients who had anaphylaxis after subcutaneous injections of isosulfan blue. Methods Two female patients with breast cancer were referred for further evaluation of allergy to isusulfan blue. Both patients had recent histories of intraoperative anaphylaxis to isosulfan blue during sentinel node biopsies. Neither patient had prior exposure to isosulfan blue. Both patients were skin tested with isosulfan blue. Results The first patient had a positive prick skin test to full strength isosulfan blue. The second patient had a negative immediate prick skin test to full strength isosulfan blue test and to intradermal skin tests with 1:100 and 1:10 dilutions. However, this patient developed a large late phase local reaction three hours after the 1:10 dilution of isosulfan blue which was similar to the delayed time course of her intraoperative isosulfan blue induced anaphylaxis. Conclusions Isosulfan blue can cause immediate and delayed anaphylactic reactions and skin test responses. The fact that these patients had positive skin tests and intraoperative anaphylaxis suggests that these episodes may be mediated by IgE. It is possible that cross sensitization may have occurred from exposure to related dyes found in common household items.