A patient undergoing lymphatic mapping with isosulfan blue dye may develop an allergic reaction to the dye. Montgomery et al classified the severity of the reaction based on clinical findings.
Clinical Findings
Grade
none
0
one or more of the following: "blue hives", urticaria, pruritus, generalized rash
1
systolic blood pressure >= 70 mm Hg AND no need for vasopressors (transient hypotension)
2
systolic blood pressure < 70 mm Hg AND need for vasopressors support
3
The reactions can be biphasic with a second reaction up to 8 hours after the first has stopped.
These allergic reactions can be avoided by:
(1) pretreating the patient with a steroid and histamine receptor blocker
(2) using radioactive tracer only
(3) using methylene blue or alternative dye
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