Heparin‐induced recurrent anaphylaxis

Berkun, Yackov; Haviv, Yael; Schwartz, Louis B.; Shalit, Meir

doi:10.1111/j.1365-2222.2004.02129.x

Cited by 61 publications

(37 citation statements)

References 10 publications

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“…The incidence of heparin-induced skin lesions is unknown, despite being increasingly reported. [2][3][4] Heparininduced skin lesions may be caused by at least 5 mechanisms: delayed-type (type IV) hypersensitivity responses, 2,[4][5][6] immune-mediated thrombocytopenia, 3 type I allergic reactions, 7,8 skin necrosis 9 and pustulosis. 10 Heparin-induced skin lesions may indicate the presence of life-threatening heparin-induced thrombocytopenia 11 -even in the absence of thrombocytopenia.…”

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confidence: 99%

Incidence and causes of heparin-induced skin lesions

Schindewolf¹,

Schwaner²,

Wolter³

et al. 2009

Canadian Medical Association Journal

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Background: Little is known about the incidence and causes of heparin-induced skin lesions. The 2 most commonly reported causes of heparin-induced skin lesions are immune-mediated heparin-induced thrombocytopenia and delayed-type hypersensitivity reactions. Methods:We prospectively examined consecutive patients who received subcutaneous heparin (most often enoxaparin or nadroparin) for the presence of heparin-induced skin lesions. If such lesions were identified, we perfor med a skin biopsy, platelet count measurements, and antiplatelet-factor 4 antibody and allergy testing. Results:We enrolled 320 patients. In total, 24 patients (7.5%, 95% confidence interval [CI] 4.7%-10.6%) had heparin-induced skin lesions. Delayed-type hypersensitivity reactions were identified as the cause in all 24 patients. One patient with histopathologic evidence of delayedtype hypersensitivity tested positive for antiplatelet-factor 4 antibodies. We identified the following risk factors for heparin-induced skin lesions: a body mass index greater than 25 (odds ratio [OR] 4.6, 95% CI 1.7-15.3), duration of heparin therapy longer than 9 days (OR 5.9, 95% CI 1.9-26.3) and female sex (OR 3.0, 95% CI 1.1-8.8).Interpretation: Heparin-induced skin lesions are relatively common, have identifiable risk factors and are commonly caused by a delayed-type hypersensitivity reaction (type IV allergic response). (ClinicalTrials.gov trial register no.

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confidence: 99%

Incidence and causes of heparin-induced skin lesions

Schindewolf¹,

Schwaner²,

Wolter³

et al. 2009

Canadian Medical Association Journal

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“…In Table 3, all published cases of immediate type hypersensitivity reactions to heparins with a complete allergologic work-up are listed [10,11,12,13,14,15,16,18,20]. Analogous to our 2 cases, in most patients the heparin causative of the immediate type hypersensitivity reaction was an LMWH.…”

Section: Discussionmentioning

confidence: 87%

“…Immediate type hypersensitivity reactions to heparin compounds seem to be very rare, and only a few cases have been published so far [6,7,8,9,10,11,12,13,14,15,16,17,18]. Based on skin tests, the most likely pathomechanism seems to involve an IgE-mediated reaction.…”

Section: Discussionmentioning

confidence: 99%

Immediate Type Hypersensitivity to Heparins: Two Case Reports and a Review of the Literature

Cesana¹,

Scherer²,

Bircher³

2016

Int Arch Allergy Immunol

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Immediate type hypersensitivity reactions due to heparins are rare, and the exact immunologic pathomechanism has not been identified so far. In our 2 case reports, we describe first a 50-year-old female who received dalteparin (Fragmin®) and developed signs of an immediate type hypersensitivity reaction. The personal history revealed a previous application of dalteparin (Fragmin®). Evaluation with a skin prick test showed positive results for dalteparin. The second case deals with a 73-year-old female with a suspected immediate type reaction after the administration of dalteparin (Fragmin®). A skin prick test was negative but intracutaneous tests showed a positive reaction to the causative agent. Both cases indicated cross-reactivity reactions for low-molecular-weight heparin (LMWH) but not for unfractioned heparin (UFH) or fondaparinux. In conclusion, our case reports including a review of published cases of immediate type hypersensitivity reactions after the application of heparins illustrate this rare complication. Mostly, the causative agent can be identified with a skin test, which is highly suggestive of an IgE-mediated reaction. Therapeutic alternatives for patients with sensitization to an LMWH are UFH and fondaparinux. Both agents have a small risk of cross-reactivity compared to heparins of the same substance class.

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“…If the nonirritating concentration for a particular drug is unavailable, skin testing with the highest concentration of intradermal testing not exceeding 1 to 10 mg/mL may be considered. In case of protein allergens such as coagulation factors, insulin, protamine, and heparin, skin testing can be very reliable and helpful [14][15][16][17][18][19]. There are skin test protocols described for a variety of other agents as well, including general anesthetics [20••, 21, 22], chemotherapeutic agents [23][24][25][26], corticosteroids [27,28], and biologic modifiers [20••].…”

Section: Skin Testingmentioning

confidence: 99%

Management of Multiple Drug Allergies in Children

Dioun

2011

Curr Allergy Asthma Rep

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Children with multiple drug allergies are likely to require treatment with one or more of the drugs to which they may have had a reaction, when there is no alternate effective drug available. Detailed review of their history and/or use of appropriate diagnostic studies will help determine the potential safety of readministering the desired drug as well as the method for its readministration, most likely in the form of a drug challenge or desensitization. A practical approach to the diagnosis and treatment of children with multiple drug allergies is described in this review.

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Heparin‐induced recurrent anaphylaxis

Cited by 61 publications

References 10 publications

Incidence and causes of heparin-induced skin lesions

Incidence and causes of heparin-induced skin lesions

Immediate Type Hypersensitivity to Heparins: Two Case Reports and a Review of the Literature

Management of Multiple Drug Allergies in Children

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