Methylene Blue For Clinical Anaphylaxis Treatment: A Case Report

Discussion in 'Articles & Scientific Studies' started by marteagal, Aug 3, 2016.

  1. marteagal

    marteagal Member

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    @paymanz reminded me that I wanted to post a study on treating anaphylaxis with methylene blue.
    I found it while researching methylene blue as a possible remedy for chronic urticaria (and in an attempt to establish links between mast cell activity, histamine, nitric oxide, vasodilation ...)

    Excerpts:

    "A 23-year-old female medical student [...] suddenly presented urticaria and pruritus, initially on her face and arms, and then extending quickly to her whole body. No allergen could be identified and there was no previous personal history of allergy [...] The first medication given was oral antihistamine, but a mild improvement in symptoms and signs was only detected after administering intravenous methylprednisolone 500 mg. However, two hours after the first episode and medications, the symptoms and signs returned with the addition of vomiting. [...] The clinical situation worsened, with dyspnea, tachypnea, peroral cyanosis, laryngeal edema with severe expiratory dyspnea and deepening unconsciousness. The patient was not in a state of circulatory shock, but the urticarial lesions, angioedema and upper respiratory tract distress continued to worsen. Conventional treatment (300 mcg adrenaline injections and 1.0 g hydrocortisone), associated with other drugs like antihistamines, midazolam (20 mg), morphine (5 mg) and aerosols of beta-2 adrenergic agonists failed to reverse the imminent cardiocirculatory collapse. General sedation and curare for lung intubation and ventilatory support were considered at that moment, [...] But before undertaking this extreme solution, and based in our previous clinical and laboratory experience, a 1.5 mg/kg (120 mg) bolus of 4% methylene blue was administered, followed by one hour of continuous infusion of another 120 mg diluted in 5% dextrose 5% in water. An initial bolus dose was selected because of the severity of the anaphylaxis. Following the initial dose of intravenous methylene blue, the clinical situation reversed completely (angioedema, urticaria, vasodilatation and upper respiratory dyspnea) in less than 20 minutes, thereby avoiding tracheal intubation. [...] Around 60 minutes later, the patient did not presented any anaphylaxis symptom apart from slight eyelid edema. No new drugs were administered, and no drugs used previously were repeated. The patient was discharged home two hours later.

    We previously reported our initial cumulative clinical experience with a cohort of nine patients who developed anaphylactic shock and/or anaphylaxis and were treated with an intravenous bolus of methylene blue (1.5 to 2.0 mg/kg). As anaphylaxis and anaphylactic shock are human emergencies, and as we do not have any evidence to propose methylene blue as a first-choice drug, it is very difficult or impossible to design a randomized study that would be in accordance with ethical principles.
    Among the total of our nine patients mentioned in the preceding paragraph, two did not present circulatory collapse and only presented the major signs of anaphylaxis, as in the present case report. It is important to differentiate between the two situations (anaphylaxis and anaphylactic shock) that were reversed by methylene blue. This emphasis is based on the possibility of methylene blue use in cases of anaphylactic reactions without cardiovascular collapse. The present case report is the third case of anaphylaxis without shock in a series of nine reported cases.2,3 [...]

    Source: Rodrigues et al. (2007) Methylene blue for clinical anaphylaxis treatment: A case report
     
  2. Giraffe

    Giraffe Member

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  3. audreywalker

    audreywalker New Member

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    Very interesting! I've been having a lot of anaphylaxis reactions lately. I'm going to look into this more! Thanks for sharing
     
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