In response to communication from a member of the public, we would like to remind readers of a previous NHS alert and direct communication to health professionals about the risk of anaphylaxis from blue dyes used in marking sentinel nodes in breast surgery and in particular, Patent Blue V.[1]

When anaphylaxis happens, anaesthetists are often called upon to recognise it and lead treatment and so it is important we remain vigilant and aware of important trigger. The alert recommends that facilities for treatment of anaphylaxis are available for at least one hour after administration. In NAP6, anaphylaxis to Patent Blue had the second highest incidence, after teicoplanin of all drugs and was above suxamethonium and all NMBAs. Symptoms were often delayed after administration compared to other drugs.[2]

Anaesthetists will be familiar with the anaphylaxis treatment page in the Quick Reference Handbook.[3]
In addition, Resuscitation Council UK is shortly to issue its own stand-alone guidance covering treatment of anaphylaxis in the perioperative period.

1. Blue Dyes: Risk of Serious Allergic Reactions, MHRA, 2014.
2. Farooq, S. Chapter 18: Patent Blue Dye. Anaesthesia, Surgery and Life-threatening Allergic Reactions: Report of the Royal College of Anaesthetists’ 6th National Audit Project: Perioperative Anaphylaxis.
RCoA, London. 2018.
3. Quick Reference Handbook, Association of Anaesthetists, 2022.