Delayed allergic skin reactions due to subcutaneous heparin‐calcium, enoxaparin‐sodium, pentosan polysulfate and acute skin lesions from systemic sodium‐heparin

Abstract

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Concomitant sensitization to high and low molecular‐weight heparins, heparinoid and pentosanpolysulfate

“…Until recently, the only therapeutic alternative for our patient would have been an i.v. coumarin derivative, which, while advocated by some authors, has also been found to induce skin reactions (6). The structurally unrelated polypeptide hirudin, produced by recombinant techniques, has now become commercially available (7).…”

Tolerance to the synthetic pentasaccharide fondaparinux in heparin sensitization

“…The structural similarities of high and low molecular‐weight heparins entail a high likelihood of cross reactions between different kinds of heparin preparations. The heparinoid danaparoid‐Na and the related pentosanpolysulfate have frequently been used as alternatives, yet we and others have reported on skin reaction to the latter as well (1, 2) and a cross‐reactivity between heparins and the former has also been described (3, 4). Hirudin which has been used as alternative drug for patients with heparin induced thrombocytopenia (5) has also been shown to cause delayed‐type hypersensitivity reactions (6, 7) and its repeated application has even led to fatal outcomes.…”

“…Adverse reactions to various kinds of heparins (high and low molecular‐weight) are a well known problem in daily clinical practice (1). Whereas immediate‐type reactions to heparins are rare, delayed‐type reactions have been increasingly reported in recent years (1). Lesions usually develop 2–4 days after injection and are erythematous, infiltrated and sometimes eczematous in nature.…”

Low-molecular-weight heparin-induced skin necrosis

“…Although no prospective studies have been performed, this complication appears to be extremely rare, since only a limited number of cases of UFH-induced skin necrosis and seven cases (including our case) after LMWH have been reported. In addition, a number of cases of erythematous skin reactions after administration of UFH [9,10,21,23,24] and LMWH [9,10,13,18,21] have been described. In the seven cases of LMWH skin necrosis (Table 1) the lesion developed after about 1 week of treatment, starting with painful erythema and progressing within a short time to necrosis.…”