Eczematous infiltrated plaques to subcutaneous heparin: a type IV allergic reaction

Abstract

SUMMARY Two patients are described who had delayed reactions with eczematous plaques to subcutaneous injections of heparin. Subcutaneous challenge with high and low molecular weight heparin compounds were positive in both patients. Patch and intradermal tests with heparin were positive in one subject. Histological and immunohistochemical studies indicated that it was a type IV allergic reaction.

Drug patch testing in systemic cutaneous drug allergy

“…The most frequent reports of positive drug patch tests are related to the following drugs: betalactam antibiotics (Romano et al, 2002), especially amoxicillin (Barbaud et al, 1998b(Barbaud et al, , 2000Van Ketel, 1987, 1989;Bruynzeel et al, 1985;Romano et al, 1993Romano et al, , 1995Barbaud et al, 1997;Vega et al, 1991;Felix and Comaish, 1974), cotrimoxazole (Klein et al, 1995), corticosteroids (Barbaud et al, 1998b;Dooms-Goossens, 1995;Bircher et al, 1996;Kilpio and Hannuksela, 2003), heparin derivatives (Barbaud et al, 1998b;Bircher et al, 1990;Moreau et al, 1996;Figarella et al, 2001), pristinamycin (Barbaud et al, 1998bMichel et al, 1996), carbamazepine (Barbaud et al, 1998b(Barbaud et al, , 2000Vaillant et al, 1989;Silva et al, 1982;Camarasa, 1985;Romaguera et al, 1989;Jones et al, 1994;Rodriguez-Mosquera et al, 1991;Alanko, 1993;Corazza et al, 1995;Puig et al, 1996), diltiazem (Barbaud et al, 1998a(Barbaud et al, , 1993Romano et al, 1992;Cholez et al, 2003), hydroxyzine (Barbaud et al, 1998b;Michel et al, 1997), pseudoephedrine …”

Incidence and causes of heparin-induced skin lesions

“…The incidence was as high as 7.5%, which is far above the generally expected incidence of 2%. 15 During this trial, 9 additional patients with heparin-induced skin lesions were referred to us by colleagues not participating in this investigation. These patients were not included in the cohort of patients presented here.…”

Pharmacology of Heparin and Related Drugs

“…Such reactions are often related to the use of LMWH, which is administered subcutaneously, and can be characterized as allergic reactions or related to HIT. The incidence of skin lesions was recently assessed in a clinical study and was found to be much higher at 8% (Schindewolf et al, 2009) than the previously accepted incidence of 2% (Bircher et al, 1990). There are three types of skin lesions, with the most frequent being delayed hypersensitivity, then immediate hypersensitivity, and the least common being skin necrosis (Warkentin, 1996).…”