{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T05:35:09Z","timestamp":1761975309920},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,7]]},"abstract":"\n Background:<\/jats:title>\n Anaphylaxis and anaphylactic-like reactions in the perioperative period are a significant concern for anesthesiologists and surgeons. With an incidence as high as one in 3500 and a mortality rate of 3 to 6 percent, proper management of these reactions is essential. The available surgical literature provides varied and unclear guidelines for determining the nature of these reactions and has no consensus treatment algorithm. The authors present a rare case of hypersensitivity reaction to methylene blue during cleft lip repair. A review of current literature for best-practice evaluation and management guidelines follows.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Literature review was performed using search terms including \u201canaphylaxis,\u201d \u201chypersensitivity,\u201d \u201callergy,\u201d \u201cperioperative,\u201d and \u201cintraoperative.\u201d Results from basic science literature, case reports, and clinical studies were used, as were personal communications with leading investigators in allergy and immunology.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Despite variations in incidence, reporting, evaluation, and management, the authors found that immediate treatment should include epinephrine, steroids, and histamine-1\u2013 and histamine-2\u2013blocking agents. In the event of reactions with characteristics of anaphylaxis, obtaining tryptase levels 1, 4, and 24 hours after the event provides the most accurate biochemical evidence. Skin-prick and intradermal testing by an allergy specialist should be performed 6 or more weeks after the reaction.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n With the unique exposure risks in the perioperative period, it is the surgeon's responsibility to aid in the proper immediate and short-term treatment of anaphylaxis and anaphylactic-like reactions. Proper biochemical evaluation at the time of reaction can be critical in helping the patient avoid future reactions and should not be overlooked.<\/jats:p>\n <\/jats:sec>\n \n CLINICAL QUESTION\/LEVEL OF EVIDENCE:<\/jats:title>\n Therapeutic, V.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/prs.0b013e318254b2b8","type":"journal-article","created":{"date-parts":[[2013,1,2]],"date-time":"2013-01-02T17:38:26Z","timestamp":1357148306000},"page":"98e-105e","source":"Crossref","is-referenced-by-count":10,"title":["Anaphylactic-Like Reaction to Methylene Blue"],"prefix":"10.1097","volume":"130","author":[{"given":"Aviram M.","family":"Giladi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Kasten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-34-20231119","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/S0950-3501(98)80034-2","article-title":"Anaphylactic and anaphylactoid reactions.","volume":"12","author":"Wittington","year":"1998","journal-title":"Baillieres Clin Anaesthesiol"},{"key":"R2-34-20231119","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1093\/bja\/87.4.549","article-title":"Anaphylaxis during anaesthesia: Results of a two-year survey in France.","volume":"87","author":"Laxenaire","year":"2001","journal-title":"Br J Anaesth"},{"key":"R3-34-20231119","first-page":"363","article-title":"What investigation after an anaphylactic reaction during anaesthesia Curr Opin Anaesthesiol.","volume":"21","author":"Dewachter","year":"2008","journal-title":""},{"key":"R4-34-20231119","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1097\/ALN.0b013e3181bbd443","article-title":"Anaphylaxis and anesthesia.","volume":"111","author":"Dewachter","year":"2009","journal-title":"Anesthesiology"},{"key":"R5-34-20231119","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.iac.2007.03.006","article-title":"Peri-anesthesic anaphylaxis.","volume":"27","author":"Chacko","year":"2007","journal-title":"Immunol Allergy Clin North Am"},{"key":"R6-34-20231119","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.jaci.2011.03.003","article-title":"Anaphylaxis during anesthesia in France: An 8-year national survey.","volume":"128","author":"Mertes","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"R7-34-20231119","first-page":"229","article-title":"Anaphylaxis during anaesthesia: Diagnosis and treatment.","volume":"55","author":"Soetens","year":"2004","journal-title":"Acta Anaesthesiol Belg"},{"key":"R8-34-20231119","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.mcna.2010.04.002","article-title":". 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Refractory anaphylactic cardiac arrest after succinylcholine administration.","volume":"109","author":"Baumann","year":"2009","journal-title":"Anesth Analg"},{"key":"R12-34-20231119","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1017\/S0265021502000418","article-title":"Allergic reactions occurring during anaesthesia.","volume":"19","author":"Mertes","year":"2002","journal-title":"Eur J Anaesthesiol"},{"key":"R13-34-20231119","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1034\/j.1399-6576.2001.045003315.x","article-title":". 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Anaphylaxis to dyes during the perioperative period: Reports of 14 clinical cases.","volume":"122","author":"Mertes","year":"2008","journal-title":"J Allergy Clin Immunol"},{"key":"R20-34-20231119","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/j.1399-6576.2006.00912.x","article-title":"Anaphylactic reaction to patent blue V after sentinel lymph node biopsy.","volume":"50","author":"Dewachter","year":"2006","journal-title":"Acta Anaesthesiol Scand"},{"key":"R21-34-20231119","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1213\/01.ANE.0000153497.60047.80","article-title":"Severe anaphylactic shock with methylene blue instillation.","volume":"101","author":"Dewachter","year":"2005","journal-title":"Anesth Analg"},{"key":"R22-34-20231119","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.athoracsur.2008.07.017","article-title":"Use of methylene blue for catecholamine-refractory vasoplegia from protamine and aprotinin.","volume":"87","author":"Del Duca","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"R23-34-20231119","first-page":"271","article-title":"Methylene blue for refractory hypotension: A case report.","volume":"76","author":"Weissgerber","year":"2008","journal-title":"AANA J"},{"key":"R24-34-20231119","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1097\/00000542-200309000-00007","article-title":"Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000.","volume":"99","author":"Mertes","year":"2003","journal-title":"Anesthesiology"},{"key":"R25-34-20231119","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S0750-7658(97)85882-0","article-title":"Substances responsible for peranesthetic anaphylactic shock: A third French multicenter study 1992-1994 (in French).","volume":"15","author":"Laxenaire","year":"1996","journal-title":"Ann Fr Anesth Reanim"},{"key":"R26-34-20231119","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/S0091-6749(99)70440-9","article-title":"Diagnostic performance of Food and Drug Administration-cleared serologic assays for natural rubber latex-specific IgE antibody. 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