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Related Experiment Videos

Type IV hypersensitivity to subcutaneous heparin: a new case

M A Gonzalo Garijo1, F Revenga Arranz

  • 1Allergology Department, Infanta Cristina University Hospital, Badajoz, Spain.

Journal of Investigational Allergology & Clinical Immunology
|November 1, 1996
PubMed
Summary

This study confirms delayed-type hypersensitivity to heparin (H) and low molecular-weight heparin (LMWH). Skin reactions at injection sites indicate cross-reactivity between these anticoagulant treatments.

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Area of Science:

  • Dermatology
  • Allergy and Immunology
  • Pharmacology

Background:

  • Low molecular-weight heparin (LMWH) like nadroparin calcium is widely used for anticoagulation.
  • Previous exposure to unfractionated heparin (H) may predispose patients to reactions with LMWH.

Observation:

  • A 71-year-old woman developed pruritic skin lesions at nadroparin injection sites.
  • Biopsy revealed spongiosis and a superficial perivascular infiltrate with lymphocytes and eosinophils.
  • Re-challenge with nadroparin induced similar lesions, confirming hypersensitivity.

Findings:

  • Epicutaneous and intradermal tests demonstrated delayed-type hypersensitivity to both unfractionated heparin and LMWH.
  • Patch tests showed persistent erythematous reactions to all tested heparins.

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  • Intradermal testing elicited infiltrated, erythematous plaques with vesicles, indicative of a delayed hypersensitivity reaction.

    • Implications:

    • These findings highlight the potential for delayed-type hypersensitivity and cross-reactivity between unfractionated heparin and LMWH.
    • Clinicians should consider hypersensitivity reactions in patients developing skin lesions after heparin administration.
    • Further investigation into the immunological mechanisms underlying heparin hypersensitivity is warranted.