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Basophil activation test in the diagnosis of patent blue V anaphylaxis

2015; Elsevier BV; Volume: 115; Issue: 1 Linguagem: Inglês

10.1016/j.anai.2015.05.002

1534-4436

Monica Boita, Sabrina Mietta, Luisa Bommarito, Giovanni Rolla,

Allergic Rhinitis and Sensitization

Hypersensitivity reactions to subcutaneous injections of patent blue V (PBV) are well recognized, with an estimated incidence ranging from 1% to 2% when all reactions are considered and severe reactions being observed in 0.2% to 1.1% of cases. 1 Mertes P.M. Malinovsky J.M. Mouton-Faivre C. et al. Anaphylaxis to dyes during the perioperative period: reports of 14 clinical cases. J Allergy Clin Immunol. 2008; 122: 348-352 Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar , 2 Scherer K. Studer W. Figueiredo V. Bircher A.J. Anaphylaxis to isosulfan blue and cross-reactivity to patent blue V: case report and review of the nomenclature of vital blue dyes. Ann Allergy Asthma Immunol. 2006; 96: 497-500 Abstract Full Text PDF PubMed Scopus (86) Google Scholar PBV, also known as E131, acid blue 3, and disulfide blue, belongs to the group of triarylmethane synthetic dyes. [3] Haque R.A. Wagner A. Whisken J.A. Nasser S.M. Ewan P.W. Anaphylaxis to patent blue V: a case series and proposed diagnostic protocol. Allergy. 2010; 65: 396-400 Crossref PubMed Scopus (41) Google Scholar Since the 1960s, these dyes have been used in different medical procedures and particularly in intraoperative lymphatic mapping and sentinel lymphadenectomy. [1] Mertes P.M. Malinovsky J.M. Mouton-Faivre C. et al. Anaphylaxis to dyes during the perioperative period: reports of 14 clinical cases. J Allergy Clin Immunol. 2008; 122: 348-352 Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar In a recent multicenter retrospective study, patent blue dye was reported as causing anaphylaxis during general anesthesia in 5% to 6% of cases. [4] Krishna M.T. York M. Chin T. et al. Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom: aetiology and diagnostic performance of acute serum tryptase. Clin Exp Immunol. 2014; 178: 399-404 Crossref PubMed Scopus (95) Google Scholar Blue dyes also are used as excipients in food. Hypersensitivity reactions have been reported only in association with parenteral administration and never after blue dye ingestion as a food excipient. In many reported cases, positive skin prick test (SPT; or intradermal test) reactions and increased concentration of serum tryptase [3] Haque R.A. Wagner A. Whisken J.A. Nasser S.M. Ewan P.W. Anaphylaxis to patent blue V: a case series and proposed diagnostic protocol. Allergy. 2010; 65: 396-400 Crossref PubMed Scopus (41) Google Scholar have supported the hypothesis of an IgE-mediated reaction. In fact, Wöhrl et al [5] Wöhrl S. Focke M. Hinterhuber G. Stingl G. Binder M. Near-fatal anaphylaxis to patent blue V. Br J Dermatol. 2004; 150: 1037-1038 Crossref PubMed Scopus (56) Google Scholar demonstrated the presence of specific IgE to PBV (and to isosulfan blue, with which antibodies to patent blue strongly cross-react) using an enzyme-linked immunosorbent assay.