Farooque Consultant in Allergy Imperial College Healthcare NHS Trust What We Already Know Reported as a cause of anaphylaxis since the 1960s Cardiovascular collapse is the commonest presentation ID: 1044325
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1. Patent Blue DyeSophie FarooqueConsultant in Allergy; Imperial College Healthcare NHS Trust
2. What We Already KnowReported as a cause of anaphylaxis since the 1960sCardiovascular collapse is the commonest presentationAllergic reactions can be delayedCan interact with the pulse oximeter falsely low saturations
3. Incidence of Anaphylaxis to Patent Blue DyeFourth most common cause of anaphylaxis in NAP6Teicoplanin (16.4 per 100,000)Patent Blue Dye (14.6 per 100,000 administrations)Suxamethonium (11.1 per 100,000)
4. DemographicsNine casesNone were fatalProfound hypotension was commonTwo thirds of patients required transfer to critical careSurgery completed in seven patients but abandoned in two
5. Presenting FeaturesOne third of patients had no skin signsUrticaria was a presenting feature in only one patientHypotension was the commonest presenting featureHypotension was universal in all casesDesaturation was the second commonest presenting feature
6. LatencyReactions can be delayedIn five patients more than 10 minutes after injectionIn two patients more than 60 minutes after injection
7. Diagnostically Challenging.Delay in onsetFalsely low pulse oximeter readingsSkin signs are rarely a presenting featureDynamic tryptase change seen in 75% of patients
8. ResuscitationGood (2)Good and Poor (5)Poor (2)Adrenaline CPR
9. Allergy Clinic AssessmentGood (4)Good and Poor (2)Poor (1)Not assessed (1)Failure to investigate all culprit drugs
10. ReferralsGood correlation between anaesthetists’ suspicion and confirmation by the allergy clinics and the NAP6 review panelReferrals mostly goodMethylene blue/Patent blue mixed upProceeded straight further surgery
11. What Do If Surgery is Abandoned?Urgent allergy clinic assessmentProceeding with surgery before allergy clinic investigationNon-operative treatments.Communicate!Urgent discussion with the allergy clinic is likely to be useful
12. Key RecommendationsConsentDo not assume patent blue dye is the culpritRefer. Evaluate all drugsIf pulse oximeter saturations fall during anaphylaxis, assume it is real. Take a blood gas once the patient is stable
13. Thank you