Delayed-Type Hypersensitivity and Cross-Reactivity to Heparins and Danaparoid: A Prospective Study

Abstract

DTH to heparins is characterized by considerable cross-reactivity between LMWHs, UFHs, and danaparoid. UFHs may be tolerated even if LMWHs are not. Subcutaneous testing of a panel of heparins, danaparoid, and desirudin (hirudin) is recommended to determine acceptable treatment options for patients allergic to specific heparins.

Tolerance of fondaparinux in a patient allergic to heparins and other glycosaminoglycans

“…The patient described here shows DTH responses to a wide spectrum of heparins as well as other glycosaminoglycans, a constellation repeatedly reported (1, 4). Our observation documented here suggests that the synthetic pentasaccharide fondaparinux might provide a safe alternative in those patients.…”

“…Delayed‐type hypersensitivity (DTH) reactions to subcutaneously injected heparins are fairly common, and cross‐allergy with different types of heparins is frequently observed (1).…”

Tolerance to intravenous heparin in patients with delayed‐type hypersensitivity to heparins: a prospective study

“…Occasionally, a generalized eczematous reaction supervenes (Estrada et al , 2003). Cross‐reactivity with the heparinoids danaparoid and pentosanpolysulphate is common (Grassegger et al , 2001). Even with the introduction of newer anticoagulants [direct thrombin inhibitors, activated factor X (factor Xa) inhibitors], such as lepirudin, desirudin, bivalirudin and fondaparinux, heparin remains the drug of choice, particularly for intravenous anticoagulation (Hyers, 2003).…”

Non‐immediate heparin and heparinoid cutaneous allergic reactions: a role for fondaparinux

“…Significant risk factors identified for such reactions include treatment duration >9 days (odds ratio (OR) 5.9), obesity (BMI > 25; OR 4.6) and female sex (OR 3.0) . For diagnosis, subcutaneous testing is considered the gold standard as false negative results are seen with intracutaneous testing and patch testing . Typical histological findings from biopsies of cutaneous reaction sites exhibit dermal oedema and mixed perivascular infiltrate with increased eosinophils …”

“…1 For diagnosis, subcutaneous testing is considered the gold standard as false negative results are seen with intracutaneous testing and patch testing. 2,3 Typical histological findings from biopsies of cutaneous reaction sites exhibit dermal oedema and mixed perivascular infiltrate with increased eosinophils. 3 Identification of an alternative anticoagulant in cases of non-immediate cutaneous hypersensitivity can be challenging (Box 1).…”