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Updated: Jul 13, 2026

Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation

Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation

Published on: May 2, 2013

Acute generalized exanthematous pustulosis from dalteparin.

Peter Komericki¹, Robert Grims, Birger Kränke

¹Department for Environmental Dermatology and Venereology, Medical University of Graz, Graz, Austria. peter.komericki@meduni-graz.at

Journal of the American Academy of Dermatology

|July 6, 2007

Summary

A patient experienced a generalized pustular drug eruption after a localized reaction to dalteparin, a low molecular-weight heparin. Testing revealed cross-reactivity to several other heparins, highlighting potential hypersensitivity risks.

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Area of Science:

Pharmacology
Dermatology
Immunology

Background:

Heparins, including low molecular-weight heparins (LMWHs), are standard treatments for venous thromboembolism.
Immunologically mediated reactions to heparins can manifest as delayed-type hypersensitivity at injection sites.
Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse drug reaction.

Observation:

A female patient developed a localized reaction to dalteparin, progressing to a generalized rash resembling AGEP.
Subcutaneous provocation testing demonstrated cross-reactivity to multiple LMWHs and heparinoids, including enoxaparin, certoparin, reviparin, nadroparin, danaparoid, and fondaparinux.
Reactions to danaparoid and nadroparin patches included pustule formation, preceding the generalized rash.

Findings:

This case represents the first documented instance of a pustular drug eruption linked to LMWHs.
The patient exhibited a broad cross-reactivity pattern to various heparin preparations, indicating a shared antigenic determinant.
Pentosan polysulfate did not elicit a reaction, suggesting differential immunogenicity within glycosaminoglycans.

Implications:

Clinicians should be aware of the potential for severe cutaneous reactions, including AGEP, to LMWHs.
The findings necessitate careful consideration of heparin selection in patients with a history of hypersensitivity reactions.
Further research into the immun mechanisms underlying heparin-induced hypersensitivity is warranted to improve patient safety.