Patent Blue V dye anaphylaxis: experience of Australian and New Zealand surgeons

Abstract

Background: Patent Blue V dye (PBVD) can cause severe anaphylaxis. For sentinel node biopsy (SNB) in breast cancer patients, controversy exists as to the utility of PBVD in addition to lymphoscintigraphy. This survey assessed Australian and New Zealand breast surgeons' experience of anaphylaxis with PBVD.

Methods: The survey was distributed to all 180 members of the BreastSurgANZ society in May 2011. Seventy-six (42%) current members responded. A retrospective analysis was performed on survey responses.

Results: Seventy-five members used PBVD on a median of 50 cases per year (0-250 cases per year) for a median of 10 years (4 months-15 years). Overall, 44 members (58.7%) experienced definite or possible allergic reaction to PBVD, but only 16 members (21%) witnessed severe anaphylaxis associated with a fall in blood pressure. Of the 34 members who experienced what they considered definite anaphylactic reactions with PBVD, only 18 members confirmed with allergy testing. The overall reported incidence of anaphylactic reactions of any severity was 0.15%. The median time to anaphylaxis was 20 min (0-90 min). Forty members (53.3%) reported routine discussion about PBVD risks as part of informed consent. Only seven members performed routine pre-op skin testing. Overall, 91% of the members accepted the rare but real risk of severe anaphylaxis and 76% did not question the additional value associated with its use.

Conclusion: Australian and New Zealand breast surgeons' reported that the anaphylaxis rate from PBVD was 0.15%. The majority of surgeons continued to use PBVD to facilitate SNB.

Keywords: Patent Blue V; anaphylaxis; breast cancer; sentinel lymph node biopsy.