Allergic reactions to isosulfan blue during sentinel node biopsy--a common event

Surgery. 2001 Sep;130(3):439-42. doi: 10.1067/msy.2001.116407.


Background: Sentinel lymph node (SLN) dissection in the management of high-risk melanoma and other cancers, such as breast cancer, has recently increased in use. The procedure identifies an SLN by intradermal or intraparenchymal injection of an isosulfan blue dye, a radiocolloid, or both around the primary malignancy.

Methods: At the time of selective SLN mapping, 3 to 5 mL of isosulfan blue was injected either intradermally or intraparenchymally around the primary malignancy. From October 1997 to May 2000, 267 patients underwent intraoperative lymphatic mapping with the use of both isosulfan 1% blue dye and radiocolloid injection. Five cases with adverse reactions to isosulfan blue were reviewed.

Results: We report 2 cases of anaphylaxis and 3 cases of "blue hives" after injection with isosulfan blue of 267 patients who had intraoperative lymphatic mapping by the procedure described above. The 2 patients with anaphylaxis experienced cardiovascular collapse, erythema, perioral edema, urticaria, and uvular edema. The blue hives in 3 patients resolved and transformed to blue patches during the course of the procedures.

Conclusions: The incidence of allergic reactions in our series was 2.0%. As physicians expand the role of SLN mapping, they should consider the use of histamine blockers as prophylaxis and have emergency treatment readily available to treat the life- threatening complication of anaphylactic reaction.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Anaphylaxis / chemically induced
  • Anaphylaxis / physiopathology
  • Drug Hypersensitivity / epidemiology*
  • Drug Hypersensitivity / etiology*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Rosaniline Dyes / adverse effects*
  • Sentinel Lymph Node Biopsy*
  • Urticaria / chemically induced
  • Urticaria / physiopathology


  • Rosaniline Dyes
  • iso-sulfan blue