Intraoperative Anaphylaxis Following Injection of a Bleomycin-Gelatin Solution for Sclerotherapy

Abstract

During the perioperative period, the most commonly identified agents that are responsible for acute allergic reactions include antibiotics, neuromuscular blocking agents, opioids, chlorhexidine, and iodinated dyes for radiologic imaging. However, whenever an allergic reaction is suspected, all of the agents to which the patient has been exposed must be considered. Although bleomycin is utilized as the primary agent for sclerotherapy in the treatment of vascular malformations, other substances such as Surgiflo ® may be added to the bleomycin solution to increase its efficacy and promote thrombosis of the smaller vessels. These products are derived from animal collagen and contain gelatin which may lead to an allergic reaction. We present an 11-year-old girl undergoing sclerotherapy treatment of an extensive left lower extremity venous malformation who subsequently developed perioperative hemodynamic instability requiring intervention after receiving an injection of a bleomycin and Surgiflo ® solution. Further investigation identified gelatin in the Surgiflo ® as the causative agent of the allergic event. Previous reports of such reactions are reviewed and the perioperative care and treatment of patients who experience anaphylaxis is addressed.

Allergy in Cancer Care: Antineoplastic Therapy-Induced Hypersensitivity Reactions

“…However, we managed to identify at least one case report of anaphylaxis to bleomycin in a patient with Hodgkin’s lymphoma and a case of fatal angioedema 48 h after drug administration [ 83 , 84 ]. Not related to cancer, another case report described an intraoperative allergic reaction following the injection of bleomycin for sclerotherapy [ 85 ]. Nevertheless, it also appears that bleomycin has the potential to aggravate atopic dermatitis and stimulates airway hyperactivity and inflammation in mouse models, therefore more work is needed to elucidate the underlying reaction mechanism [ 86 ].…”