• A Hamelin, A Vial-Dupuy, B Lebrun-Vignes, C Francès, A Soria, and S Barete.
• Service de dermatologie-allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: auroredeblignieres@gmail.com.
• Ann Dermatol Vener. 2015 Nov 1; 142 (11): 670-4.

BackgroundPatent blue (PB) is a lymphatic vessel dye commonly used in France for sentinel lymph node detection in breast cancer, and less frequently in melanoma, and which may induce hypersensitivity reactions. We report a case of acute blue urticaria occurring within minutes of PB injection.Patients And MethodsTen minutes after PB injection for sentinel lymph node detection during breast cancer surgery, a 49-year-old woman developed generalised acute blue urticaria and eyelid angioedema without bronchospasm or haemodynamic disturbance, but requiring discontinuation of surgery. Skin testing using PB and the anaesthetics given were run 6 weeks after the episode and confirmed PB allergy. PB was formally contra-indicated.DiscussionImmediate hypersensitivity reactions to PB have been reported for between 0.24 and 2.2% of procedures. Such reactions are on occasion severe, chiefly involving anaphylactic shock. Two mechanisms are probably associated: non-specific histamine release and/or an IgE-mediated mechanism. Skin tests are helpful in confirming the diagnosis of PB allergy.ConclusionBlue acute urticaria is one of the clinical manifestations of immediate hypersensitivity reactions to patent blue dye. Skin tests must be performed 6 weeks after the reaction in order to confirm the diagnosis and formally contra-indicate this substance.Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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