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Background Intraoperative anaphylaxis during sentinel lymph node biopsy is a well known phenomenon occurring with administration of patent blue and isosulfan blue dyes, with an incidence of 2.2% and 1.1%, respectively (1,2). Methylene blue has been reported as being a safer alternative with only a few case reports demonstrating anaphylaxis and large studies demonstrating no incidence of anaphylaxis in 224 patients (3,2).

Prolonged elevation of serum tryptase resulting from intraoperative anaphylaxis to methylene blue