PMID- 24461090
OWN - NLM
STAT- MEDLINE
DCOM- 20141124
LR  - 20181203
IS  - 0151-9638 (Print)
IS  - 0151-9638 (Linking)
VI  - 141
IP  - 1
DP  - 2014 Jan
TI  - [A study of 19 cases of allergy to heparins with positive skin testing].
PG  - 23-9
LID - S0151-9638(13)01697-9 [pii]
LID - 10.1016/j.annder.2013.10.040 [doi]
AB  - BACKGROUND: Allergic hypersensitivity to unfractioned or low-molecular-weight 
      heparins is uncommon but is known, and in particular the most common form is 
      localized dermatitis, although such cases have seldom turned into maculopapular 
      exanthema. Since cross-reactions with other heparins are frequent, identification 
      of therapeutic alternatives is essential. PATIENTS AND METHODS: This 
      retrospective study included patients referred to the Department of Dermatology 
      and Allergology at Tenon Hospital between 2000 and 2012 with suspicion of allergy 
      to unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) and 
      sensitized to at least one heparin (i.e. positive skin tests to at least one 
      heparin). The heparins and hirudins used were tested in the forearm by means of 
      intradermal skin tests. All patients were contacted in 2012 to establish whether 
      they had used some form of heparin since the cutaneous allergy tests. RESULTS: 
      Nineteen patients had at least one positive skin test for heparin; 1 patient had 
      presented anaphylactic shock, while 18 others had presented localized eczema (12) 
      or generalized dermatitis (6). The heparin most often responsible for these 
      adverse reactions was enoxaparin (13/19). An LMWH was responsible in most cases 
      (18 vs. 1 with UFH). Of these 18 patients, 16 also presented positive skin tests 
      for UFH, 9 for synthetic heparinoid and 1 for hirudin. 11/19 patients were tested 
      for fondaparinux (a synthetic pentasaccharid) and all had negative skin tests. 
      5/7 patients with negative skin tests had taken fondaparinux without any visible 
      reaction, whereas 2 who also tested negative experienced localized eruption at 
      the injection site. DISCUSSION: Our results underline the greater frequency of 
      delayed hypersensitivity reactions compared with immediate reactions to heparins. 
      Skin tests can help to identify substitution molecules. Fondaparinux might be an 
      alternative but certain diagnosis relies on rechallenge.
CI  - Copyright (c) 2013 Elsevier Masson SAS. All rights reserved.
FAU - Phan, C
AU  - Phan C
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France. Electronic address: cel.phan@gmail.com.
FAU - Vial-Dupuy, A
AU  - Vial-Dupuy A
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
FAU - Autegarden, J-E
AU  - Autegarden JE
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
FAU - Amsler, E
AU  - Amsler E
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
FAU - Gaouar, H
AU  - Gaouar H
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
FAU - Abuaf, N
AU  - Abuaf N
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
FAU - Pecquet, C
AU  - Pecquet C
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
FAU - Frances, C
AU  - Frances C
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
FAU - Soria, A
AU  - Soria A
AD  - Service de dermatologie et allergologie, hopital Tenon, AP-HP, 4, rue de la 
      Chine, 75020 Paris, France.
LA  - fre
PT  - Journal Article
TT  - Etude de 19 cas d'allergie aux heparines prouvee par des tests cutanes.
DEP - 20131202
PL  - France
TA  - Ann Dermatol Venereol
JT  - Annales de dermatologie et de venereologie
JID - 7702013
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Heparinoids)
RN  - 0 (Hirudins)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anaphylaxis/diagnosis/etiology
MH  - Anticoagulants/*adverse effects
MH  - Cross Reactions
MH  - Dose-Response Relationship, Immunologic
MH  - Drug Eruptions/diagnosis/*etiology
MH  - Drug Hypersensitivity/diagnosis/etiology
MH  - Eczema/*chemically induced/diagnosis
MH  - Female
MH  - Fondaparinux
MH  - Heparin/*adverse effects
MH  - Heparin, Low-Molecular-Weight/adverse effects
MH  - Heparinoids
MH  - Hirudins
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Polysaccharides
MH  - Retrospective Studies
MH  - *Skin Tests
MH  - Young Adult
OTO - NOTNLM
OT  - Allergic hypersensitivity
OT  - Allergie
OT  - Dermatitis
OT  - Eczema
OT  - Fondaparinux
OT  - Heparin
OT  - Hypersensibilite
OT  - Heparine
OT  - Skin tests
OT  - Tests cutanes
EDAT- 2014/01/28 06:00
MHDA- 2014/12/15 06:00
CRDT- 2014/01/28 06:00
PHST- 2013/07/19 00:00 [received]
PHST- 2013/09/20 00:00 [revised]
PHST- 2013/10/29 00:00 [accepted]
PHST- 2014/01/28 06:00 [entrez]
PHST- 2014/01/28 06:00 [pubmed]
PHST- 2014/12/15 06:00 [medline]
AID - S0151-9638(13)01697-9 [pii]
AID - 10.1016/j.annder.2013.10.040 [doi]
PST - ppublish
SO  - Ann Dermatol Venereol. 2014 Jan;141(1):23-9. doi: 10.1016/j.annder.2013.10.040. 
      Epub 2013 Dec 2.