PMID- 35788063
OWN - NLM
STAT- MEDLINE
DCOM- 20221114
LR  - 20221125
IS  - 2213-2201 (Electronic)
VI  - 10
IP  - 11
DP  - 2022 Nov
TI  - Delayed-Type Heparin Allergy: Intravenous Tolerance Despite Inflammatory Skin 
      Reaction After Subcutaneous Injection.
PG  - 2977-2983.e1
LID - S2213-2198(22)00653-5 [pii]
LID - 10.1016/j.jaip.2022.06.030 [doi]
AB  - BACKGROUND: Heparin allergy most frequently manifests as delayed-type 
      hypersensitivity (DTH) causing an itchy inflammatory skin reaction at the site of 
      subcutaneous injection. An important differential diagnosis is circumscribed skin 
      necrosis due to heparin-induced thrombocytopenia. OBJECTIVES: An inflammatory 
      skin reaction to subcutaneously injected heparin generally entails the quest for 
      alternative anticoagulation; concerns may particularly arise in an emergency 
      situation requiring intravenous heparin administration. METHODS: All heparin DTH 
      cases seen in our department over the last 17 years underwent standardized 
      allergy diagnostics including challenge testing, that is, subcutaneous injection 
      of fondaparinux and intravenous administration of unfractionated heparin (UFH). 
      RESULTS: Of a total of 50 patients with confirmed heparin allergy, DTH was found 
      in 48 (96.0%), and immediate-type, presumably IgE-mediated hypersensitivity was 
      diagnosed in only 2 (4.0%). In the 48 DTH cases, intradermal testing revealed 
      broad cross-reactivity between UFH and low-molecular-weight heparins (LMWH) 
      including nadroparin, dalteparin, and enoxaparin. Cross-reactivity with (or 
      concomitant sensitization to) fondaparinux was seen in only 3 (6.3%) cases. 
      Intravenous administration of UFH was tolerated by all 45 patients challenged, 
      despite DTH to UFH and LMWH as demonstrated by intradermal testing. CONCLUSIONS: 
      If an inflammatory skin reaction at the site of subcutaneously injected heparin 
      is observed or reported without any evidence of skin necrosis or 
      thrombocytopenia, intravenous administration of UFH seems to be sufficiently safe 
      and may be considered without allergy testing if urgently indicated in an 
      emergency situation. Fondaparinux is the most suitable alternative for 
      subcutaneous application.
CI  - Copyright (c) 2022 American Academy of Allergy, Asthma & Immunology. Published by 
      Elsevier Inc. All rights reserved.
FAU - Trautmann, Axel
AU  - Trautmann A
AD  - Department of Dermatology and Allergy, University Hospital Wurzburg, Wurzburg, 
      Germany. Electronic address: trautmann_a@ukw.de.
FAU - Gran, Franziska
AU  - Gran F
AD  - Department of Dermatology and Allergy, University Hospital Wurzburg, Wurzburg, 
      Germany.
FAU - Stoevesandt, Johanna
AU  - Stoevesandt J
AD  - Department of Dermatology and Allergy, University Hospital Wurzburg, Wurzburg, 
      Germany.
LA  - eng
PT  - Journal Article
DEP - 20220702
PL  - United States
TA  - J Allergy Clin Immunol Pract
JT  - The journal of allergy and clinical immunology. In practice
JID - 101597220
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Anticoagulants)
SB  - IM
CIN - J Allergy Clin Immunol Pract. 2022 Nov;10(11):2984-2985. PMID: 36357050
MH  - Humans
MH  - *Heparin/adverse effects
MH  - Fondaparinux/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Anticoagulants/adverse effects
MH  - Skin Tests
MH  - *Drug Hypersensitivity/diagnosis/drug therapy
MH  - Injections, Subcutaneous
MH  - Administration, Intravenous
MH  - Necrosis
OTO - NOTNLM
OT  - Anaphylaxis
OT  - Drug adverse reaction
OT  - Drug allergy
OT  - Drug hypersensitivity
OT  - Eczema
OT  - Exanthema
OT  - Fondaparinux
OT  - Low-molecular-weight heparin
OT  - Unfractionated heparin
EDAT- 2022/07/06 06:00
MHDA- 2022/11/15 06:00
CRDT- 2022/07/05 18:00
PHST- 2022/04/05 00:00 [received]
PHST- 2022/06/09 00:00 [revised]
PHST- 2022/06/18 00:00 [accepted]
PHST- 2022/07/06 06:00 [pubmed]
PHST- 2022/11/15 06:00 [medline]
PHST- 2022/07/05 18:00 [entrez]
AID - S2213-2198(22)00653-5 [pii]
AID - 10.1016/j.jaip.2022.06.030 [doi]
PST - ppublish
SO  - J Allergy Clin Immunol Pract. 2022 Nov;10(11):2977-2983.e1. doi: 
      10.1016/j.jaip.2022.06.030. Epub 2022 Jul 2.